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FOR OFFICE USE: ------------------- - - `APPLICATION FOR SANITATION PERMIT Permit No. ----------------- i (Complete in Duplicate)p ) . Date Issued " ---------------- ------------- --------------- This Permit Ex ires 1 Year From Date Issued --------- ------ ------ -------------- --- herein described. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ATION _. `"-�-- - -- --------- Phone -------------- ------------ Owner's Name -------------------- •---------------- i --- --- -------- - Phone - -----------•------------- Address ------------- X- -- ----------- Contractor's Name----- ----- -- ------ Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ le Motel ❑ Other . Number of living units: -A--- Number of bedrooms __ Number of aths .._ -_ Lot size -_- - ----------------------------- tem Community system ❑ Private Depth to Water Table ft. Water Supply: Public system ❑ Adobe Hardpan Character of soil to a depth of 3 feet: Sand El Gravel El Sandy Loam [I Clay Loam El Clay ❑ ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspoolpermitted if.-public sewer is available within 200 feet.) Material------------------------- Septic Tank: Distance from nearest well_..._..--. ui.._...Distance from foundation..._.. -Ca Capacity_ ------- � ' Liquid deep•th-- P Y ❑ No. of compartments--------------- Size ------------------------------ q t Dispos field: pistance from nearest well_... ___.---..Distance from foundatio on.. *' __„-_Width ofnce ttre chest--2--/line_-- ----------- `y ^� Length of each line-..----"------ Number of lines g "_----Total length-----��-- ------ i Type of filter rriaterial------s�7 .a -----Depth of filter material...../.y' f I 1�_______.pistance to nearest lot line-.-->.......-.- _. r Seepag it: Distance to nearest we4l._.../-4_ ________pistance from foundation_-.__ y y De t'n.._a- ,----------------- / Linin mSize; Diameter----• -- -- ---- P Number of pits.}.-..--/------ 9 I 1 ` Cesspool: Distance from nearest well--------- ------Distance from foundat.ion__.._.=`-......-...Lining materia _-..__....._..__.--------------•--- .Li uid Ca acit gals. 1- ------ --------------------Depth--------------------- --------- G P Y -- Size: g------------------------------•----------- -11pistance from .I .................'- -M �1 stance from nearest building Diameter- nearest well ---------------- ❑ XN Distance to nearest lot line-------------------------------------- ----- - Remodeling and/or repa ------•------------------------------------------ ing (describe}: " ---------------- - - ------------ -.}--------------- ---------------------------------------- -----------'------------ ------------------ ----------------------------------------•----------- -- ------------------------------------------------ = = ------------------------------------- I I hereby certify that I'have p epared.this application and that the work will be done in accordance with San Joaquin County { ordinances, at laws, and rules and teguletions of-the-San-Joaquin Local,Health-District.1 .1 , 4• - -- rl I 1 F s - ----------- ---------ti--- ------ (Signed)--- r Contract ... (Si ned ---1------------ -- --- 9 (Title) --- -- -------- . . --- 1 I --------- By: --- ------ f - --------- ---- e (Plot plan, s wing size of lot, location of ystem in r tion to wells, buildings, etc., can be placed on Peverse side]. ' FOR DEPARTMENT USE ONLY ! --------------------------- - PATE--=---- -------------- _ -- APPLICATION ACCEPTED BY.--- =- .� DATE REVIEWED BY----------------- ---.................... --..----- -- ---- ---- - --.............. ----- DA. - BUILDINGPERMIT rISSUED.------------ ------------------------------- -------------------------•-- ---" --------------------------------------------------------------------- Alteratians and/or recommen att€ns:---------- ------ -------- - - ------ -----------"-•---- --------------------------------------------------------------------- ------------------------------------------------ ---- -------- _-- ---------"--------}----- --------- --- -- -------. ------------------------- ---------- ---------- Date..l..'a 4-7---------- t SAN JOAQUIN LOCAL HEALTH DISTRICT l 1801 E.#fazelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Lodi,California Manteca,California Tracy,California Stockton,California F.P-CO.