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F R OFFICE USE: f Permit No. -%••-•`-- % 3 � -------------------�� APPLICATION FOR SANITATION PERMIT -------------------------------------------- ------------------------------ -------- (Complete in Duplicate) Date issued ---�-•�QA� - --- -- --.--- This Permit Expires 1 Year From Date Issued 1. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein escn e . This application is made in compliance,with County Ordinance No. 549. ----------------------------- ---- --- --- --- --------- JOB ADDRESS AND LOCATION------- f i ------ Phonef ^ - ' Owner's Name--------------- ----------------- Address--------------------------- Contractor's Name----------- --•---- --• � l Installation will serve: Residence [2-Apartment House ❑ Commercial ❑ Trailer Court ❑ l ❑ Other ❑ ?--_• Number of baths --/--- Lot size ----------- / ' -------------- - Number of bedrooms �/ Number of living units: __/--- o Water Supply: Public system ❑ Community system ❑ Private [ Depth to Water Table -' ft' Hardpan El Character of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam El Clay Loam M,--,Clay E] Adobe ❑ f VA: Yes ❑ No �" Previous Application Made: (If yes,date----------- -----) No (� New Construction: Yes E] No © FNA/ I 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 foundatiLquid de th--Material_--._:---Capacity_____ ---------------- ❑ No. of compartments---------------------------well_��__ --- -Dize________________ - - - q P• �stance from foundation___�eP '--------Distance to nearest lot ------ Disp�oos,allF/Fi�eld: Distance from nearest Width of trench-_ ��------ Number of lines_f ------- ---------Length of each line__/Or1'------ -Depth of filter material---&I---------Total length-----1t�e-_------------------------ Type of filter material____ �/�6z- Seepage Pit: Distance to nearest well----------------------Distance from foundation ._____.Distance to nearest lot line_--____-___-____ I ❑❑ Size: Diameter-- ---------- -------Depth- ------------------------ ------ Number -----Number its-----------------------Lining material-------------- ------- arest well_________________Distance from foundation_____.--------------Lining material---------------------------------alsCesspool: Distance'from ne -----------g -----------Depth-------------- ------ ---------------- i u d CaacitY Size: Diameter__r . \_t� Distance from nearest well------------------------------------------------- Distance from nearest building--------------------------------------- Privy: _ ------------------- -- Distance to nearest lot line------------- . ------- ------ ----------------- t. Remodeling and/or repairing (describe):_____-___.0- ` ------------------- [ ---------------- ----------------------------------- ----------•----------------------------------------------- her c----- that i have -----------------•--------------------- -------------------I.L - ----- ..her-------cer ------------ I he y y prepared this application and that the work will 6e dans in accordance with San Joaquin Countyi ordinances, Stat�ja rules a6d regulations of the San Joaquin Local Health District. w and/or Contractor) (Signed)---------------- ---------l''-'-r` _ - �Ioc m relation to wells, buildin s, etc., can(bteeplaced on revers��'f ------------------------------------ ------ By•---------•------- _ e side). (Plot plan, showing size of g r ( FOR DEPARTMENT USE ONLY - ----------------------------------------- DATE--------- ` - ---------------- I APPLICATION ACCEPTED BY_---.C�__ -- --- REVIEWED BY-------------------------------- -- ----------------- - DATE--- ---------- --------------------•---------•-------- ---------------------------- DATE._. - -- ------------------- ----------------------------- IBUILDING PERMIT ISSUED----------- ------------•--------------------------------------------- ---•-••-------------- ------------------------------------------- ----------------------- Alterations and/or recommendattons:___-_-.--_.------- - ------------------------------------------------------ ---------------------- ---------=- ---- --- - --------------------- --- - - ------------------------------------------............. ---------- ------------- ---------------------------------------- -------------------- -------------------------- ------- --- < < 4 :. Date--------- P' 3 " .�2 ----- - ----------------------------- FINAL INSPECTION BY:.-- --:.-------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Stree! 124 Sycamore Street 205 West 91h Street 1401 E.Haielton Ave. Lodi,California Manteca,California Tracy,California Stockton,California — F.RCO-