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FOR OFFICE USE: �. Z_ APPLICATION FOR SANITATION PERMIT Permit No. .czld�..f�.... ------------ --- -- ------------------------------------- (Complete in Duplicate) 1 ---.-- - ___ 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 hereVdescrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TION--------------JL._.------ - -- `-------?---------------------------------------------------------•---------------------------- Owner's Name ---------� /� Phone-.--•---------------------------- ----------------- -- Address . T'/ '��` ------ -- ---- Contractor's Name------ e ` ,V_,e�f 4 1�--- �f e -Phone. Installation will serve: LResidence D�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms:' 'Number of baths __l--_ Lot size -------------------------------------- Water Supply: Public;system t4 Community system ❑ Private ❑ Depth to Water Table -... ff.� Character of soil to a depth of 3 feet: Sand E] Gravel .❑ Sandy Loam ElClay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date---_-----------------I No Eg"' New Construction: Yes ❑ No 1" FHA/VA: Yes ❑ No E� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt-----------------Distance from foundation------------------- Material...---..----.---------------------.t-n----.-----. ❑ No. of compartments--------------------------Size-------------------------- -----Liquid depth-------- ----Capacity_-------------------- Dispcsal apacity_-------------------- disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- El -____ ----.❑ Nu'mber of lines--!-------------------------------Length of each line-----------------------------Width of trench--------------.---------- ---- Type of filter material-------------------------Depth of filter material-----------------------Total length-------:1---------------------- Seepage it: Distance to nearest well-----►-------------Distance frolK foundation---/�P--- .---.Distance to nearest lot line---:7;T.j._- Number of pits----'..- _Lining material-_ `��Size: Diameter-,_, ��__`P..__.Depth_------ P --------- ----------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------.------------------ ❑ Size: Diameter----) ------------- ------- Depth--------------------- ---------- - ---------------Liquid,Capacity°---------------- -----gals. Privy: Distance from ne test well:--`.:.-.:-'r':' "�- '_---.-_ -----_ Distance from net est building----. w r------------------------------ ❑ i --------------------------------- Distance to nearest lot line------------------------- -- - ------------�-�------------ ------ Remodeling and/or repairing (descril!e):_------ `- G1----------� b ~rr ------ --------------------------------- ----------- -- -A - -. . ._. --- - - -- -------------- --------------- kI---------------- I _ . . - ------------------------- ------------------------------ -----,----------------------------------------------------------------------------------------- ------ ----------------------- -------------------------------- I hereby certify that I have prepared this application and that the work will be d e,in accordance withkan Joaquin County ordinances, State laws, and rules regulat' f the San Joaquin Local Health s rice. --------r, ._ (Signed) ,!° .- 1 — -- ------ rand/or Contractor) By ------ t, -------------- -----------------Title----- - --------------- ------ (Plot plan, showing siz of lot, locaH n of system in relation to-wells, buildings;etc., earl be placed on reverse side). ( R DEPARTMENT USE ONLY t � � ` 1 4------------- APPLICATION ACCEPTED BY---- --- ------ --- ------ - ---------------- ------ --------- ----= DATE----- - - REVIEWEDBY I---------------------- ---- -- ------------- --------------------- ----------- DATE--------------------i BUILDING PERMIT ISSUED ----------- ` DAT ' --------- ----- - - -- Alterations and/or recomrnenc�a+ions:""" .= „ ----- SG�' ------------------------------------------------------------ --' --- --- - ------- -----------_-------- '=--- = / ------- -------- -------------------------------•------------------------- -------------- --------------------------------------------------- ------------------ - ---- ------------------------------- ----------------- ---------------------- ---- -- ------- ------------------------------------------------------------------ ----------------------------------------------------------------------------------------- ------------------------------------------------------- -------- ----- -------------------------------------------------- -----------`---------------------------------------------------- FINAL INSPECTION BY:. �• ---`-'--------------------------- Date =/��d6-------- -- -- N JOAQUIN LOCAL HEALTH DISTRICT ; 1601 E.Nozelion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockfan,California Lodi,California Manteca,California Tracy,California