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FOR OFFICE USE: � � G _ ____________ -- APPLICATION FOR SANITATION PERMIT Permit No. .au-)Z� =. ---- (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 and install the work herein described. This application is made in compliance Gwith - CountY OrdinanceNo.-5542. 9------------JOB ADDRESS AN _ --r Pho --------------- Owner's p-- -- -- ------- -- Owner s Name________ � 3 1 .t t Address_- - .--- ---• -------------- ----•--------f--------------•------------------•-•--------/-----•-------•------•---- Contractor's Name------------------------- --------------•---- Phone..1_W_- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _6--- Number of bedrooms _46-- Number of baths j6-_- Lot size _--- Water Supply: Public system ❑ community system El Private [Depth to Water Table' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [j Sandy Loam [I Clay Loam E) Clay E] Adobe U Hardpan ❑ Previous Application Made: (if yes,date.__.___-"`__.._----I No ❑ Newi Construction: fYes ❑ No [ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ti ' nk: Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------ . No. of compartments-- -------------- ----Size------ --------- ---------Liquid depth-- Capacity_... k ¢ . s oss F, }Distance from nearest well.------------_----Distance from foundation-------- ------------Distance to nearest lot line----------------- Number of lines---------------------- ------------Length of each line------ -----------------------Width of trench------------------------------------ 0 --------- -------------------- -- /T of filter material__------..__-__.--.---.-Depth of filter material----------------------- otal length_------.____---:--..-------------------- -Type Seepage Pit: Distance to nearest well_1D__©---------Distance from foundation--/O-_-._--.Distance to nearest lot line_- ..__ D •_ Number of pits. _ -" ``-----Lining material__ 13.C/le-Size: Diameter---33.. --_ p 7 Cesspoolt: #Distance from nearest well-----------------Distance from foundation...._._..__.__-___..Lining material-------------------------------------- , ❑ .Size: Diameter--1------------"----------------------Depth_ .-------------------------------------------------Liquid Capacity--- ga{s, y I Privy: Distance from nearest well------------- ----------------------------------_Distance from nearest building-------------------------------------- ---------- ;.__. ❑ Distance to nearest lot line'_------- - ------------------------------- Remodeling and/or repairing (describe)...... ; �� -------------------------------- i ------------------------------�-_-_____-______.______-____.___ _._____...___------------------------------__------------ •" ---------------------------------------------""------- I ------------------ ----------------------------------------------- k I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rul s and gialations of the San Joaquin Local Health District. E.E-r ------------------------- -(Owner and/or Contractor) - ---- ------------- ----- (Signed) , ---- -- -- - r (Title)_.. _ ------------ (Plot plan, showing size of lot, location of system in relation to we buildings, etc., can be placed on reverse side). 1. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---"--------------- --------- DATE-" `� � ---------- ------- --------- REVIEWEDBY------------------------------------ ---------------- DATE----- - ---------------------------------------------------- . BUILDING PERMIT ISSUED = ti - DATE._ Alterations and/or recommendations:__. 1G.� `- .�`-� i --------•---------------------------•----------•-------•-- -------------------•-------•----- --------------- ---------------------------------------------------------- � .- i<//T = 1a -------------------- --- ------------ FIN f�L INSPECTION BY:------, __t..L�------ --- - -------- --- Date-- --------- - --- %' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slotkton,California Lodi,California Manteca,California Tracy,California F.P.0 O.