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FOR OFFICE USE: <br /> --------------- - -------- p <br />---------------------- ---------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _-_.. .------ <br />-------------------------------- <br /> ---- . <br /> ------------- ------------------- -------- (Complete in Duplicate) <br /> � Date Issued --------------------- <br /> _ __ _--___-_----------- -------------- ----------- This Permit Expires 1 Year From Date Issued <br /> Application is'hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance7 with County Or i Pe No. 549. Ii <br /> - - ----- -----------------------------•------------------------------------------ <br /> JOB ADDRESS AND LOCATION-___'----- <br /> - � ------�� -- ------ ---- - `� <br /> Owner's Name------------- - .. .. . - -----------------•---=----------------- ------------- ----------------------- Phone-------------------------------•---- <br /> 1 1 C1 ---------------------------------------------------------------------------- <br /> Address =-------------------------•-•------ <br /> Contractor's Name------------------------------------- ------ ------ ------------- Phone------------------•-------•-----... <br /> Installation will serve:' Residence Apartment House ❑ Commercial Trailer Court ❑ Motel Other <br /> El <br /> r `�) - z-Q <br /> Number of living units: --Z- Number of bedrooms _.Z-- Number of baths ---�_ Lot size -----._-------- ------ - <br /> Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table 5^I1 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej-__H n ❑ y <br /> Previous Application.Made: (If yes,date----.--_.-,.-------1 No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> . r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> F <br /> Se 'c Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material ---..------------.-----------------------------•- <br /> No. of compartments--------------------------Size-----•------------------- ---Liquid depth-------------------------.Capacity----------------------- <br /> i Field: Distance from nearest well:2�64WDjstance from foundation---f v - Distance to nearest lot line---- -------- <br /> 1 <br /> Number of lines---'---�_---.__-- -. Length of each line---- __�-------------Width of trench---.-a --- --- --------- <br /> Type of filter material ----•--�-- -A---__-Depth of filter material---l_ --__ ---.Total length---------------------9____--------.---. <br /> Seepage Pit: ' Distance to nearest well------ ---------------Distance from foundation--------------------Distance to nearest lot line----------------- r <br /> ❑ Number cif pits -----------------Lining material----_. ----------------Size: Diameter-----------------------Depth------=-------------------------- <br /> Cesspool: Distance''from nearest well-----------------Distance from foundation.--------------------Lining material_-..------------------------------. <br /> El Size, Diameter---- -------- ------------------- ---Depth----------- ------------------ 4.- ---------------- Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well______________________________----------------___Distance from nearest building_..-.---------------------------------- <br /> ❑ , Distance to nearest lot line------------------------------ ------------------------------•------------------------------------------- - --------------- C� <br /> Remodeling and/or repairing (describe):-------- --- -------------------- ---------------------------------------I--------------------- ------------------------------------------------- 2 I <br /> t - <br /> -----------------------------------•------------------- <br /> ------------------------------------------------------------ <br /> ------1----- --- ---- ----------------------------------•------------------------------------------------------------------------------- <br /> - -- - - - -- - - - - ------------------ - -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,5fate laws, and rules and regulations of the San Joaquin Local Health-District. <br /> -g-' / <br /> (Signeal'd) - (Owner and/or Contractor] <br /> ----- - -------------------- <br /> By:-------••------------------ - ---------------------------------- (Title) -:01- �� --------- ---- - -------------- <br /> (Plot plan, showing size of lot, location of sys to relation to wells, buildings, etc., can be laced off reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--_ . � <br /> DATE-------�2_',;Z_3-----�?J --------------- <br /> REVIEWEDBY------- ------------ ---------------- ----------------- --------------------------- --------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- ----- -------------------------------------------------------------------- ---------------- DATE----------------------------------- ---------------------- -- <br /> Alterations and/or recommendations:------------------------ = --------------------------------------------------------------------------------------------- ------------ <br /> -------------- <br /> ----------------- -------------------------------------•---- ---------------- --------------------------------- ----------------------- ----------------- - -------------- <br /> ----------------------------------- ---- - ------ <br /> FINAL INSPECTION BY:- Date----- sem' L� ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> 5totkf*n,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br /> F <br />