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_ s - FOR OFFICE SE: =7 -- ----- ��- -- i / _ 3 APPLICATION FOR SANITATION PERMIT Permit No. ..,l.. -.��. -. -i�----------- ------------------------- - I (Complete in Duplicate) - ---- ------------------------- ----------------- I 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 the work herein described. This application is made in compliancewithCounty Ordinance No. 549. JOB ADDRESS AND LOCATION-- .. y� Owners Name.., r.. ------------------------------- Phone Address - i------------------•- Contractor's Name.............. `` � " Phone. Installation will serve: Residence Apartment House ❑ -Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: __ __ Number of bedrooms,,__ Number of baths _2?�.__ Lot size Y awll!t.-- ---=-------------------•-------------- � Water Supply: Public system El Community system ❑ Private �epth To Water Table W/4fft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @--Fiardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No [&--FHA/VA. Yes [Y'No C3 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_____-..___.___._.____.____.------_________----- /�Ep 1;fAOF No. of compartments---------------------------Size--------------------------------Liquid depth-------------------------Capacity------------.-•----- t jF Disposal Fielpl. Distance from nearest well ----- Distance from foundafion_j-,�....".._.Distance to nearest lot line-- Width f✓'__.. wz6� � Number of lines--- Length of each line_.__ 0----_--------.-. of trench_y.e2.- .--.------------------. Type of filter materiaL� Depth of filter material____ - ..__To#al length_____-Z0__________________ _�_.. I Seepage P}t: istance to nearest well_._ �.._____Distance from foundation_..,� ____....Dlstce to nearest lot `�a ,Number of pits---_1I-------------Lining material_ ---Size: Diameter_�� --------Depth_,.-- -- _------- r`1 1 Ql Cesspool: Distance from nearest well__---------------Distance from foundation-------------------- material____.______._______.________......_._ ti ❑ Size: Diameter----- --------------------- ----------Depth----------------------------------------------------Liquid Capacity----------•--•---------•- -gals. ------------------------- I Privy: from nearest building Privy: Distance from nearest well------------------------------------------ --- - 9------------•--------------------••------ ❑ Distance to nearest lot line-------------•------------------ ---•---•---------•-------------------------•----- ------------ Remodeling and/or repairing (describe)____________________ .---- --- -• - - - --- - ------------------------ ----- ............ ...................... •---------•----------- ................... -•-------------•----------••---•--••-----•---••------•-•-•--------------- hereby certify that I have prepared this application an that the work wl l be done in accordance with San Joaquin County ordinances, State laws,aandrullsand, regulat' ns of the San Joaquin Local Health District. `. tr Contractor) SI ned - ( 'g y -- '--... i --------(Title)-- �/1�--------.".-- ---------"-------- (Plot plan, showing size of lot, locatio�t of system in relat' to wells, buildings, etc., can be placed on reverse side). t I` FOR DEPARTMENT USE ONLY /, DATE.. `�------- I' APPLICATION ACCEPTED BY4 7� Qy' — 1-- _ REVIEWEDBY----------- ------------------------ ------------------------------------------------------ •------------ DATE_... BUILDING PERMIT ISSUED----------- ------------ � ._...__ �4- ---- - C,, LATE Alterations and/or recommen afions: '- 9 '- — x . ... j - ------------ ....... ------ ------------------------------ - -- - ------------ -------------------- 'FINAL INSPECTION BY______________ ------ Date..---( ----------------------------•--•---- __�_._.____..- �"� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerlcan Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street 516iklan,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS