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F R OFFICE USE: ------------- ----1---------- ------ ----._..__..........................__-.----- - - APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------- ------------------ (Complet�,jn Duplicate) This Permit Ex ire. 1 (ear 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.. S This application is made in compliance with County Ordinance No. 549.,` JOB ADDRESS AND LOCATION � -- `� lam(/ 1�1�R. =A•e G: . Owner's Name_/! ___ ------------- Phone--------------------•--------------- 66 Address__I1__ ___._ v �� 4 --------------------------------------------- -- -•--------------------------------- -- ---•---•--------------•----•----------•---- Contractor's Name �'`" ` t'� --- ------- ------------- ------------------ -------------- Phone----------------------------------- Installation will serve: Residence lr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ 1_. Number of bedrooms __I-_._ Number of baths_!_._._ Lot size -------------------------------- Water _Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table 41_ 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--- ---_ --_ 1 No ..[Z;?----New Construction: Yes ❑ No [?I---FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if,public sewer-is-available within" 200 r Septic Tank: Distance from nearest weil_S�-----_Distance from fou7dation._� t!-------Material ------_-----____------------------.-_______... [ No. of compartments.--Zr_ --.---- -----Size--- --?�e x-_Liquid depth__.----!_..._... _ p y �_Q_y4se,� Ca acit d Disposal Field: Distance from nearest well.ra�v_�__ Distance from foundation__/a.___-._____._.Distance to nearest lot (� Number of lines ___I-----------------------------Lenth g of each -- ------------------ Width of trench---"2----�------------------- lin ` Type of filter materia�t�Uk__-___-_Depth of filter material/�-______ ________Total length--------Sb_�--------------------- Seepage Pit: Distance to nearest well_____________ ________Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits--- ------------------Lining material------------------ --. Size: Diameter_.--------------------Depth--------------------------------- Cesspool Distance from nearest well ________________Distance from foundation- - -._.___...--- Lining material-------------------------------------- 11 ___._._-__-_ ______.__.❑ Size: Diameter- -- -------- ----- -- - ---- - -Depth- ------------- ............ -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------______.......Distance from nearest building------------------------------....... ._..- ❑ Distance to nearest lot line - - --- ------- - - - ---------- - ---- ------------------------------------------------------------- --------- Remodeling and/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, State laws, and rules ndregul=ions �thean oaquin Local Health District, (Signed)--------------- -------------- [----- ------------ .............._. ---------------------------------- ---------------------------------------(Owner and/or Contractor) . . - - - Y•=-------------------- -- �---=-- -�-�`_-==--- --= ='------------- ---------------(Title) '' - ...... -- --- ----- - (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i .,� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ r ---------------------- ----- DATE----------9 1,, _..4- --------------------------- REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------- -•-------- DATE BUILDING PERMIT ISSUED----- -- -- ---------------------------------------------------- -- ------------- �------- DATE------------------------------- ---- - Alter .ons nd/or rec�mm ndations:------------- --- -------- ----------------------- ----- t — - ---- y----------------------------- - - - --- - - t-4 A L.I.nI f5-------- -----�HA�-----ee v4 A ---- 3 'r Rock r------------------- ----------- - -- ----- -------------------- FINAL INSPECTION BY:-- «!�-__ _C//� Date------------ .-.fes-�--` ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocktanr California Lodi California f 41. Manteca, California Tracy,California E.H.9 2M 1.57 Vanguard Press