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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .r,; -,� � ----------------------------------- ---------- --------- (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 construe and i stall the work herein described. This application is made in Zcompliance with County Ordinance No. 549. JOB ADDRESSiAD LO ATIO -�_ r�� -- e- _ !-- - Owner's Name------- --------•-- -_*IV --a� - - - �---=-- --------'_------------ ---------- Phone Address--•---------_--- - - - •---•--•-------------------------•- - --------*---------- Contractor's Name----------------- --------- `"�" - ---------- Phone----------------------------------- Installation willeserve. Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units:r--- Number of bedrooms _ Number of baths -------- Lot size ----------- ------------------------------------------------ Water Supply: Public system ❑ Community system ❑ Private e Depth t Water Table -------- ft. ` Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well-_--.5'A 1---Distance from foundation-_._/4----_......Material....el:Ze3R---- -------------------- � - No. of compartments--------. ------------Sizelr_X_ _-�--I �--�----._--Liquid depth----'`?�:------------------Capacity_��a Dispos Field: Distance from nearest well_-_"- Distance from foundation---14........... to nearest lot line------_1------ Number of lines--------- -----I-----------------Length of each line--------.vB.................Width of french.A--'-,------------------------ Type of filter material---------- --..Depth of filter material----_---!I "_.....Total length------ `---------------------.__.- Seepage Pit: Distance to nearest well-----------------_---Distance from foundation--------------------Distance to nearest lot line----------------- EJ Number of pits---------------- --Lining material-----------------------Size: Diameter-------------- -----Depth------------------.------------- Cesspool: Distance from nearest well.-,-1-----------Distance from foundation--------------------Lining material------------------------------------ El Size: Diameter----------------- -------------Depth---------------------------------------------------Liquid Capacity----------------- gals. Privy-. Distance from nearest well------------------------------------------------Distance from nearest building----------------------------- J ❑ Distance to nearest lost line ; ---- - ------- ------- -------------- ------------ -- ------------------------------------------------ Remodeling ---------- - --------- --------- ---- i Remodeling and/or repairing (describe):--–--------------- ---------------------------------------------------------------- ---------- -----• Vb ------------------------------•--------------------------------------------------------------------`--------------------------------------------- -------------------- -------------------------------------- -----------------------------------------------------------------------------------------------•------------•-•---------------------------•------•---------------------------------------------------------------------- ----------- --------------------------------- ---------------------------------------------------------- -- -'-------------------------------------------------------------•------------------------------:--------- 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 and regulations of the San Joaquin Local Health District. (Signed)_---- ----- --- ---- - - ----- ------------------- - - -- ------------------------------------------------------------- ,.( WRW and/or Contractor) By:- ---- ---------- -------------- ------------ - - --- ------- ---------------- ----- -------------- ._{Title)__ (Plot plan, showing size of lot, location of syst m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY_. -- -- -z / ---------------------------------------------------------- DATE_An- -- "___p- .._-.-.___-_.________.--..---- REVIEWEDBY-------------------------------------------------- ------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ ---------------- DATE---------------------------------------------- ------------ --/ Alterationsand/or recommendations:----------------------------- -------------------------------------------------- --------------•-•---------------------- .---------•----------------------- ------------------------- ------------------------------------------ ---------------------------- ----------------•-------------------------------•---•---------------•------------------- ---•-------------------------- ----- ----------------•-------------------- ----- ------------ ------------------- ----- ✓// f ate r FINAL INSPECTION ------ D SAN JOAQUIN LOCAL HEALTH DISTRICT k. 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street ' 205 West 9th Street Slockton,California Lodi,California Manteca,California Tracy,California F F.P.CC.