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FOR OFFICE USE: -----------I------- - ------------y:` 5 x ------------------ -- - - APPLICATIOAI#FOR SANITATION PERMIT Permit No. .....�_. ._ ,v - --------- - -------------------- -------- (Complefe-in Duplicate) - dD This Permit Ex fres 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__.. _/7........ 2, Owner's Name__ !! � r- - - - --- Phone------------------------------------ Address--------- � _ ,�` ----------------------------- ---------- `------ :� ! ------� ------------------------------------------------ Contractor's Name Gr----- ..L1---------------------- ---- ------------•---------------------------•---- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . � f Number of living units: -_ _.- Number of bedrooms P._ Number of baths._Z___ Lot size _4f---__- �_✓--------------- _____ Water Supply: Publics stem d pp y: y Community system ❑ Private ❑ Depth to Water Table �� ft Character of soil to a depth of 3 fee+• Sand [:] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date.............____ I No Ry", New Construction: Yes ❑ No FHA/VA: Yes R No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well-----------Distance f m found tion__-f ---.--.Mat rial No..of compartments___pL__...............Size. -_, �Liquid depth_ .-- _._`:..Capacity 49- i r� Disposal Fie#d: Distance from nearest well.................Distance from foundation /�_-..._....Distance to nearest lot line_ . n Number of lines______ ____ _____ _________-Length-of each line--_- J __-- ��,------ .Width of trench_-11ZL----•---- Type of filter materia/��O�-�Depth of filter material_X�_.- -----.Total length_._O__�'_______________ ___ _____ • Seepage Pit Distance to nearest well-----=---------Distance fr m foundation__f*5.�.... Distance to nearest lot line__- -�.__ J Number of -----------Lining mate rial_ h _- Size: .11 C, s§pool: Distance from nearest well ____ ___________Distance from foundation-----------------_lining material-____. -------- --_------------------ V 1 ❑ Size: Diameter. ------ ----- -------------- Depth--------------------- ------- ------- --------------Liquid Capacity---- -------- -------------gals. Privy; Distance from nearest well.................................................Distance from nearest building___-._-.____-_____-_________.-.___-__... iV 3 ❑ Distance to nearest lot line ..__ ------- ---/------------------------------------------------------ Remodeling and/or repairing Idescribe):--------- -- - --------------------------------------- -------- cam, i( �' ------------------------------- ------------------------------------------------------------------------------------------ --------------------- ---------------------------------------------------------------- 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)- ------------- e .� . - �• - - --- ----- --- -------------- - -.( r Contractor) By: ------------------------------- ---- � b-- �- Title { }.{ ' (Plot plan, showing size of lot, location of sys+e relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED .BY- `-. -------------------- ---------------- ------ DATE--J� REVIEWEDBY-------------------------------------------- ----------------------- ------------------------------------------------------- DATE - BUILDING PERMIT ISSUED-------- - ------------ ----------------- ---------------- ----:------------- ---------------------- DA-TE--- Alterations and/or recommendations:____- -_- - ---?�_. __-__ r r� --------- ----------------------- ------------------------ --- ---------- , - ----- - FINAL INSPECTION BY:... -----------------------------..- .. Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Slocklon,Californfa y r Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press