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I-UK OF -K-L u5t: -------------------------------------------------------- .______._________________________________________--__-- APPLICATION FOR SANITATION PERMIT Permit - ---------- - ---- ------------------------- - -------- (Complete in Duplicate) ----.--- This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. Rd JOB ADDRESS AND OCATION_1)+ -Q�-- `------+�.v ---I`d-�-- ------------- .L � Owner's Namj----- 14-n --- - Phone Address ~T_f._ �------ - ------q.-G---------------------•-- --- - -------- ------� Contractor's Name j•--- �"�` ------ Phone-------•-----------------•--------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms ___I___ Number of baths ___f____ Lot size __________________.__-_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date..........---------.) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------_----------------------------- .____._-__. ❑ No. of compartments----- -------------------Size--------------------------------Liquid depth-------------- -----------Capacity----------------------- Dispos Yield: Distance from nearest well-_.._&--'---Distance from foundation____.!_`---.Distance to nearest lot line---S_�_.___.- [ Number of lines------------- _._. _ . Length of each line---------1..L> _ _.____._.Width of french-----7-------------------_--------- Type of filter material-------- _..�_-- ----Depth of filter material__.._1_ _ -_ __.Total length--------1_ew__'_______________________ Seepa Pit: Distance to nearest welL.___1 0.Q-_'___Distance from foundation____�_b__�_ -- : _ _____.Distance to nearest lot line__.-------------- ----------------------- Cesspool: .___-.. G Number of pits____-___I------- ___Lining material__.__- � -� Size: Diameter____-_ _' Depfh____Z-S---___-___.___.-_ Cesspool: Distance from nearest well-----------------Distance from foundation-----------------__ Lining materia!-----------------------------------.. ❑ Size: Diameter---- ----------------------------- -Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------_------- ---------------------------.-_Distance from nearest building-___-_________________-_----------------- ❑ Distance to nearest lot line- - ---- Remodelingand/or repairing (describe):------ -------------------------- --- --------------------------------------------------------------------------------------------•----------------- ------------•--•---------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- ------ -----------------------------------------------------------•---------------•-• -----------------------------------------------------------•------....--------------------------------•---------------------------------------- ---------------- ---- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,eSfafs, and rules and regulations of the San Joaquin Local Health District. (Signed) �er and/or Contractor) OY=-- -- ---- ----t--•--*oysf�e ------------ -----------------------------(Title)----------- - --------- - - -- -------------- (Plot plan, showing size of lot, locain relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -- - -------- ------------------------------------------------------ DATE REVIEWEDBY-------------------------- ------ --------------------------------- -- ------ ---------------- -----------•--- DATE } BUILDING PERMIT ISSUED ------------------------ DATE. --------- Alterations and/or recommendations-------- ------------- ----------------------- -------•--•------------------------------------------------------- ------------- -------- ----------------------------------- ----------------------------------- ------- -----••--------------------=---------------------- -------------------- -------------------------------------------- FINAL INSPECTION BY:- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Slocklon,California Lodi,California Manteca,California Tracy,California F.P.Ci1.