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FOR OFFICE USE: — 7 -------------------=---------- -------------------------- -------------- ----------------------- -------------------------_____________________________.._____- ------ ---------- APPLICATION FOR SANITATION PERMIT Permit No. __�_ ��• d ------------------------- ---------------- ---- -------- (Complete in Duplicate) S ` • ----- ----- This Permit Ex ires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in the work herein described. Thi application is made in compliance wi h CountyOrdinan e No. 549. dS p�S c . JOB ADDRESS AND L _ ATiON____________________ _ _ -�'-�� , Y------------- Owner's ;-••Owner's Nam fpt�4 r ----------- '------- ------ i' e"rrC` - Address �_-..__..;9 1 Contractor's Name----------------- --------•-••- = ------- f -------------------------------------------- Phone----....---•------- r. Installation will serve: Residence kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth, r ❑ Number of livingunits: ______.Number of bedrooms ---"Umber of baths ___�_- Lot size __-, � - ................... x 7 Water Supply: Publics stem �_ i ft PP Y= y ❑ Community system ❑ Private De th to Water Table Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam Clay Loam [] Clay [] Adobe ❑ Hardpan ❑ Previous Application Made: IIf yes,date------------ -------) No`s New Constructio f �e ',No ❑ FHA/VA: Yes ❑ Nox 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_-__.-_____---_______._ ,.No. of compartments---------- --------- -----Size---------------------=----------Liquid depth-------------_-------- Capacity--- C Dis o al Field; Distance from nearest/well-. -- Distance from foundation___.40---------Distance to nearest lot line- " Number of lines <- :r----- --- / fl ength of each line____:_ Width of trench- --. ---------------- Type of filfer ma�teriaL-_ _ -._- _-pepth of filter material- a '�__-__Total length-_-_______ -_ . . � t - �. eepage Pit: Distance to nearest well__________ __________Distance from foundation----------------------Distance to nearest lot line_.____-_________ ❑ Number of Pits--`--------------------Lining material----------:------------Size: Diameter---------------__-- _ _ . _ Depth - ----------------------- ��( Cesspool: Distance from nearest well-----------------Distance from foundation------------_-------Lining material-------____-.-_-______--_-_______-_ 'i ❑ Size: Diameter.-i-i-----------------------_----- Depth _------ -----------------Liquid Capacity- ------- ---gal,sem . Privy: Distance from nearest well _____ _ ________ -Distance from nearest building -------------- ❑ # Distance to nearest lot line-------_------'---- --- ________________________ , ------------------------------------------------------ Remodeling and/or repairing (describe)________________________ 1 ---------------------•------------------ ------•-----------------------------•-------------------------------------------- --•-------------•----•---------------:--••--------•-----------------------: •----------------------------------- ; --------------- ----•------------ ---------------------------------------- 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 o the San Joa uin Local Health District. ��`-� >� (Signed k :... ti -- --�r-�h------ --- -----\------------------------------ ----- ------- --------(Owner and/or Contractor) By:----------------•----------------------...---------------------------------- ----- - ----------------•---------------------------------[Title}----- ----------------- - --- ' - - - - - - ------------------ (Plot plan, showing siie of lot, location of system in relation to wells,.buildings, etc., can be.placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ----------------------------- DATE REVIEWE D 8Y----------------------- ------------ ----------'------------------------>- , - -------------- ------------------._ DATE--.---- - ------------- BUILDING PERMIT ISSUED---------------------------------------- �T - --- --- --- -- DATE.--------------`- ---------- ----- '----- ---------------------------- ______ A aerations and/or recommendations:_.__...-___._ - - ------------ ----------------------------------------------------------------------------------------------------------- ------------------------- ---------------- -'----------------- --------------------- ---------------------------------------------------------------------- - FINAL INSPECTION BY:-------- --- -- -------------------------------- -------------- Date------- ' ' "' .... . SAN JOAQUIN LOCAL HEALTH DISTRICT z 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street k Stocklon,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9.54 3M 3-'63 F.p.0 D. ��