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FOR OFFICE USE: ------------- -------------- -----"------ --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit N . ----------------- --- ----------------------------------- (Complete in Duplicate) Date Issued '- __ _-----____--------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a install the work herein de cribed. This application is made in compliance with County Ordinance No. 549. �" nnJJ j� O _ ADDRESS AND LOgATIO.N-•4 ------I°-� - - J --------------------- JOB Owner's Name Phone -4 a Address-------------------- ----- -' •- ------------------- --------------•----- ------------------------------------------------------------------------•----, _46.,3_1--! 1� •. Contractor's Name r3--r"��---- � ,g. -------�.�t__�___..--- t----------------------- ------ Phone_.A/ Installation will serve: Residence �partment House ❑ Commercial ❑1 Trailer Court ❑ /Motel ❑ Other ❑ fI Number of living units: ___ Number of bedrooms___- Number of bath's ____ Lot size ------------------- ______ _____ C'.•t-----�.-- � Water Supply: Public system ❑ Community system ❑ Private 24_-f7e"pth to Water Table -------- ft. Character of soil to a depth of•3 feet: Sand ❑ Gravel ❑ Sandy Loam reClay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date_._............. ..l No ❑ New Construction: Yves ❑ No 9,---FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Distance from nearest well-----------------Distance from foundation__.__--_________--_Material-------------------------________--.-__.____. (~ No. of compartments---------- ---------------Size--------------------------------Liquid depth-------------- - -- -----Capacity-----------�-- -- ..___.Distance to nearest lot line._m'7-___-_--.- s os F;aw: Distance from neayest well.-,-_Distance from foundation_ i {g Number of lines___[_______ _ ___ ______ _ ___Length'of each line_ -0.0.4-.----------Width of Type of filter -____f--.---- 6�. Depth of filter material------ -�1----Total length_______________Z-_Q�_-__________. 1 ' maters -- Seepage Pit: Distance to nearest well____ ______ _Distance from foundation--------------------Distance to nearest lot line----------_------ E] Number of pits----------------------Lining material-----------------------Size: Diameter----_----------------;-Depth---------.----------------------- � r Cesspool: Distance from nearest well-----------------Distance from foundation------------...-.__.Lining material---.-_-_.------------------ ---______. ❑ Size: Diameter- ------------------- ----------------Depth------------------------------ -- -------------- ---Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.__.__----________---__..._---_. ❑ Distance to nearest lot line--------- ------------------- --- ------------------------------------------------------------ - ------------------------------------------- Remodeling and/or repairing-----describ ----- - ------------------------ ---------------- - - ----- - ---------------------------------------------------------------------------- --------------------------- ---------------------------- ------------------------------------------------ ----- 4.- - ----- ------------------------------------------- ----------------------------- - ------------ ----------- --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t e laws, and rules and regulations of the San Joaquin Local Health District. (Signed �l-�eC� -Rrf_-- � -sLr s-----------= -------------------------- ------------------ Contractor}— By -� Title (Pla# plan, showing size of lot, location of system in rel n to wells, build' s, etc., an be placed on reverse side). I r FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED BY- ----- I-------------------------- DATE--- --------- --------------------------- REVIEWED BY------------------------- ----------------------- --------------------------------------- --- DATE------------------------ BUILDINGPERMIT ISSUED---------•-- --------------------------------------------------------------------------------------- DATE------------------------------- rAlterations and/or recommendations: ---------------------- --------------------------------------------------------------•--------------------------------------------------------------- I --------------------------------------------------------------------------------------------------------------------- ---------------------------------- --------------------------------------------------------------------------------------------------- ---------------•----- ---------------------------------------------- ------ ----------------- --------- ---------------------------------------------- - ------- ' f FINAL INSPECTION BY: /� -- ------ ------ ------------- Date-- ----------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocklon,California Lodi,California Manlecar California Tracy,California F.P.0O. 4t y 4 1