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FOR OFFICE USE: - ----- --------- - �D.eJ�S, APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued - ------------------------------------- _ _ - This Permit Expires 1 Year From Date Issue _ 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. v+ 2-3 W �1 �, •• L NJOBADDRESS A Phone ----------- ------------- Owner's ----------- Owners Name--- --- ------------- Address------------------------•------ J rPhone----------------------------------- Contractor's .--- - -- ------------ Contractor s Name----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -_- Number of bedrooms _ _- Number ❑ of baths -.3--- Lot si "' "------------------------- �- i Water Supply: Public system ❑ Community system ❑ Private [ size -- Depth to Water Table ---- ft. Character of p soil to a depth of 3 feet: Sand F-1Gravel F1 Sandy Loam El Clay Loam Clay ❑ Adobe C] Hardpan ❑ W I Previous Application Made: (If yes,date------ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic ank: Distance from nearest well P-"--Distance from foundation--------------------Material----- ------- No. of compartments--- -�- -------Size-.�-� --I_ '�--'� --Liquid depth---V- ................--Capacity�7'av Dispos Field: Distance from nearest well-._ -.-t---Distance from foundation-_.-/Q-l-_-.-.Distance to nearest lot line---------- :3 r -Width of trench ------------- ------I_ Number of lines-----------`0 --------------Length of each line------50--------- Total length----"-8 d----,---------------:--------. r Type of filter material-------�`7fl---------Depth of finer material-----/,�---.----- ` Seepage Pit: Distance to nearest well.-.-----------_--_---Distance from foundation---____---.-------.Distance to nearest of line----- ------- s ❑ Number of pits---------------------Lining material-------------- -------.Size: Diameter------------- -------- Depth--- -- - ---- Cesspool: Distance from nearest well--_-------------Distance from foundation--------------------Lining material-.-_-.-.-.-------------------------- --.-.-Li uid Capacity gals. ❑ Size: I?iameter----- ---------- ------ ---------- Depth- ---------- ---- ---- ---------- -------- q p Y--------------------------• Privy: k Distance from nearest well-----------_--------------_---- ----------- --Distance from nearest building---------..------------------------------ ❑ Distance to nearest lot line------------------------ - ---------------•------------------------- - -------- ----- ------------------------------------------------- Remadeling and/or repairing (describe)----------- -------------- ----------- --- ----- ----- ---------- ----- ------- ------ ---- --- -------- ---------__h - _ ------ -- - ---- - I hereby certif that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat awa and rules and regulations of the San Joaquin Local Health District. (Signed-� Viand/or Contractor a -- - - - ---- --- - ------- -------- -- --- ------------- ------- Title ------------ ------- ---- ------.--- ------------- (Plot plan,; showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY "wDATE----- --------47 ------------------------ I APPLICATION ACCEPTED BY-.-. - -------------------------------- - --- DATE-- -- --------------------------------------------------- REVIEWEDBY--------------------------------------------- -----------------------------------------------------------•----- ---- DATE----�-�----------- -- -------- -- -------- -------------- BUILDING PERMIT ISSUED-------------------------- ----------------- Alterations and/or recommend ations------------------------ ------------------------------------------------------------------------- -- ----------------------------------------------- -------------------------- ------------- ----- Date.--- `. "` FINAL INSPECTION BY:.-- - -- --. - --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California F-P.C d. 1 f