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`30 --- -----.- FOR-OFFICE USE:_,� --------- / -------------------------------=----- - `_ mr--_. APPLICATION FOR SANITATION PERMIT Permit No. l� . ----------------------------------------- - -------------- (Complete in Duplicate) Date Issued ---..-_-------------------_------- ------- __.._" .-_. This Permit Expires l 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION....-�f� �.�'� — ---=-=---- ------- - ------------'--------------- -------------------------------- Owner's Name------ -ti-o-x�ct- r ..._.�...... Phone Y6�1': -- -� F. ---•----------------------------•----------------------------••-------•- Address-------------i 4---y-`-------fit----. ---"' Contractor's Name---------- "o. ------------------ ----- ----•-- Phone-y;�-9�_,j_ � Installation will serve: Residence K]-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-.___ Number of bedrooms _Z-- Number of baths _I----- Lot size _-_Z�..._._-Q -------------------------- Water Supply: Public system E- Community system ❑ Private ❑ Depth to Water Table AXA^/ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [s-P�arclpan ❑ Previous Application Made: (If yes,date___________--------) No & New Construction: Yes ❑ No [�J— FHA/VA: Yes ❑ No [I— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 Septic T ink, Distance from nearest well-----------------Distance from foundation--------------------.Material _____.._---__-______._ ---________..._______.- No. of compartments--------------------------Size-------------------------------- Liqpid depth--------------------------Capacity..--------------------- Disposal Field: Distance from nearest well---- _ -----Distance from foundation---/Q---------- Distance to nearest lot line-47/_._____ a ©r Number of lines------------L_.__._------ Length of each line------�1�-----------------Wicith of trench-----z ----------------------- \ Type of filter material_---_...__Depth of filter material----_-- -J_i_____.Total length_____./Y_______________________f__-__- Q Seepage Pit: Distance'to nearest well..."""_____._.___Distance from f undation___.�_�_.�____.Dista�e to nearest lot line�_s- - �' Number of pits.-----.-4-----------Lining material----__.Size:'Diameter---3-,?_____________Dept CesspCesspool: ool: Distance from nearest well-----------------Distance from foundation___-----------_-----Lining material_-_________----_______________-_-.. _ ❑ Size: Diameter- ------------------ -------- Depth---------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well------- ------------------------------------------Distance from nearest building--------------.____________-_--_.___._---. ❑ Distance to nearest lot Line--------- ----------------------- --------------------------------------------------------------------------------------- ------------- I Remodelingand/or repairing.(describe) ------ ----------•-°---------------------------------------------------------------------------•-------------------------------------------------------- -------------------------------------------------------------- -----------------------------------------------------------•-----------------------------------------------------------------------------------------------------------------------------•-------------------------------- -- --------------------------------------------------------------------------------------------------------------------------------- -- --------- 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)----------- .. 4�------- --------------------- ----------------------------- ----=-------------- {Owner and/or Contractor) By:----------------- ---- ------ ------------------------------------------------------(Title)---------------------------- --------------- - (Plot plan, showi ize a ton of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.._ - --- ---------------------------------------- DATE_._I�-fir--/ ------------------------------ I -------- - BY-------------------------------- ---------- - --------------------------------- DATE------ --------------------------------------- •------------ BUILDINGPERMIT ISSUED----------------------------------------------------- --------- ------------ --------------------• DATE-------- ---------------------------------------------------- Alterationsand/or recommendations-----------------------------------------------------------------------------------------------••---•---------------••-------•--•---------------------------- ---------------------------- -------------------------- -------------------------.--------------------------------------- ----------------------------- ------------------------------------------------------- -- I ------------------------------------------------- ------------------------- ------ --------- --------- ------- ----------------- ----- ---- ------------------- --------------------- ----------- ---------------------•---------------------- . ry`P 214--6 l ----------- ------ --------------------------- FINAL INSPECTION BY------- ---------- -a-- -- - Date i SAN JOAQUIN LOCAL HEALTH DISTRICT { 1601 E.Haxeltoo Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street #I' Swtkton,California Lodi,California Manteca,California Tracy,California