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FOR OFFICE USE: ----------- APPLICATION FOR SANITATION PERMIT �� Permit No. ------------- ----------------------------------------- (Complete in Duplicate) ------------------ -------------------------------------- t Expi ---_._.-__ This Permires 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 hereindcribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION: Owner's Name.--- ._ -----.....-- ------�- -- �-�- r- -- --'--`=---------------------------------------------------------------•-•--••----�=:----- Pone-----•------------------ � Address --- — . _.__.... -- azye—rgo-a3 Contractor's Name-------- -- --�-.. .. •----------•----------------------------••--•--------.-----•------------------ ......... Phone Insfailation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..f___ Number of bedrooms - Number of baths Lot size ----_-•________________________ Wafer Supply: Public system ❑ Community system �rivate ❑ Depth to Water Table 40V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 20" New Construction: Yes Z?"'-No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 3 "w 7 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SAptic Tank: Distance from nearest well _.Distance from f C datio�n-_-.1-e______-M te`rial._ __f .... ..T........ No. of compartments_.._ ________________Size.l��_ Liquid depth-.. .--------------Capacity,/2gM--.-- Disposal Field: Distance from nearest well-- --------- Distance from foundation__ Distance to nearest lot line._ l Number of lines.__..___,_._;�____ .______ -Length of each line____J!S_!__ ........Width of trench__ _ ___-_�----------------_--- f r. Type of filter ma#erial�j/� -_ De th of filter material_.__ _ Total length __� __________________________- ") YP P ./X-- --� g y Seepage Pit: Distance to nearest well------_��----Distance from f undation_____•l�_. _.Distance to nearest lot line......'!:....... i Number of its_____ Linin material_ Size: Diameter__ De fh- ~� " P' --------- g '� Cesspool: Distance from nearest well-----------------Distance from foundation___ ___--Lining material__i----------................... .... th---------------------------------------------------Liquid Capacify-,, gals. ` Priv Distance from nearest well_____________________ Y =' ------------Distance"from nearest building------------------------------------------ ------------- Distanceto nearest lot line------------------------------------------------------------- ----- ---------------i-----•---------------------•--- y Remodeling and/or repairing (describe): --------••-��--- - -- -•-� -• -- - --- - -------------------------------•-------•---•---•-•- � --. _ ------------------•----------------------------------•------:__.-------....-------------------------------------------------------•--------------.----------------------------•--•----•------•--------------•----------------- 4 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 an 0 regulations of fh San Joaquin Local Health District. (Signed)-------------------------- : w ` --------------------------------------------------- or Contractor) ------------•-•--•-• ---- ----------` ----r Title (Plot plan, showing silo of lot, location of sysfe ' relation to wells, uildings, etc., can be placed on reverse side). __EOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY------------------------------------------------------ -- f�c DATE_------•--- REVIEWED BY-----------------------------------•-------- ----------------------------------- - aS -- --�--- ---- --•------ --- -- -•--._._...--------•-•- DATE-------•--------•---- ---------•-`-••----•--------••----•--- BUILDING PERMIT ISSUED----------------------- ATE-----------................------------- ------------ AFterations and/,or recommendations:__.__-_ .. �J ..__ ._._.__ ..5�_(.�.,�.. -------------•---------------------------------------------------------------------------------------------------------------------------------------•-•------------..-__.-----------•---•----------------------------------- ---•-•-------------------------------------------------------------------- -----------------------------------=---------------------------------------------------------------------------- ---------------------------------- FINAL INSPECTION BY:.. . '��C '�jJ` - ------ Date--------- S 40. �----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 91h Street ,,ST_ocktah�Callfornia Lodi,California Manteca,California Tracy,California E8 9 REVISEa a-69 PM 6-61'ATLA9