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1--UR Vi-FICE u5E: -----�------------- --- ' ------------------------------------------ -------------- APPLICATION FOR SANITATION PERMIT Permit No. ..4 1.`5..�� ------------------ ------ --- -------------- (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 9e work herein described. This application is made in compliance with County Ordinance No. 549. b JOB ADDRESS AND ATION____ -- _�-(� --_-_-------. - - ------------ Owner's Name — 1 - ------ --- Phone Address .--• ----•---------- ----------I ----------------//----------------- Contractor's Name------------------------- ------ ----•- ------------------------- Phonezl&&_ilPFZ---- Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size __-_---------------------------------------------------- Water Supply: Public system T" 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 FV Hardpan ❑ Previous Application Made. (If yes,date._-..--_-..._---.-) No F�Z New Construction: Yes ❑ No �r 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-------------------------------------.----------- Er_V1k54-1 A)6r No. of compartments---- -- -----------------Size-----------------------•------- Liquid depth------------------------- Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line---.__---_.---_- ❑o" Number of lInes-----------------------------------Length of each line---------- ---------.---------Width of trench.------------ --- Type of filter material.------------------ Depth of filter material-----------------. ----Total length------------------------------------------ Seeps e Pit: Distance to nearest well--/1`1DALE---Distanc"ormn ndation_-_:3-5------.-.Dist nc'e to nearest lot line.-1�-- ---_ Number of pits- -C1..)--Lining material-- ...Size: Diameter-- - -,___--.Depth-.--r ----. r.-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.---------------------------------- F1 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----------------------------------------•------------------------------------------------------------------------------------------------------------- I hereby certify that I h e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an ru s and regulations f the San Joaquin cal Health District. (Signed)---------------------------- -- - ------ - -- ------ ---- - ---- -------------------------------------------......(Owner and/or Contractor) By:---------------'........--- -- - --------------------(Title)-------- -------...- (Plot plan, showing size of lot, ocation of system in r ation to wells, buildings, etc., can be placed n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - C-1/----------------------------------------------------------------------- DATE------ y /6, REVIEWEDBY--------------------------------- -- -------- ---------- ---------------------------------------------------------------- DATE----- -- ----------------------- BUILDING PERMIT ISSUED---------------- ---------------------------------------------------------------------------------- DATE----------- --------- Alterations and/or recommendations:--------------------------I------------------- -----•-•-•---------------------------------.--------------------------------------------- -------------------- - ------------------------------------------ ---------------------•--------------------------------------•------------------------------------------------------....-------------_--------------------------------------- -------------------------- .............7---------------------------------------------------------------------------------------- --------------- --------------------------- FINAL INSPECTION Date '— y 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5locklon,California Lodi,California Manteca,California Tracy,California