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----------------------=---- -------- ----- -------------- "; -0 APPLICATION FOR SANITATION PERMIT Permit No. .../-/.1KCA --- --------------------------------------------------------- (Complete in Duplicate) S This Permit Expires 1 Year From Date Issued bate 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. JOBADDRESS AND'LOCAT�10 ---------- ---- - ----- -----------------------------------------------------------------�----•----------------- one Owner s Name-- `----- ----- ---� ------------------------------- --- ------- -------------------------------------�-�--� -� - ------------ ''•--------- ------------------------------------- Address I Contractor's Name-----------------•---•----- I------------ ------------------------------------------------ -• ---------------- ------ Phone---------------- ------------------ �t Installation will serve: Residence {Apartment House I] Commercial ❑ Trailer Court ❑ Motel ❑l Other ❑ Number of living units: ---t- Number of bedrooms - Number of baths A--- Lot size _--- 1-0-7 Water Supply: Public system I.Community system ❑" Private ❑ Depth to Water Table _------ ft: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clayk Adobe Hardpan ❑ r Previous Application Made: (If yesl�date-- ,-------.) No ❑ New Construction: Yes (&No ❑ FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoolpermitted if public sewr.is available within 200 feet.) I Septic Tank: Distance from nearest well___��__Distance from f11 oundat n_ ----------.Material---------------------____---------- Li e Ca acct No. sof tom artments-.-.--_._ --_------Size----- - uid dth � q p, ? -------0- p �� tante from foundation-----AQ--------Distance to nearest lot line------aS------- t Dis oral Field: Distance from nearest well------- ------Di 6gth of each line----_-- -------------Width of trench.-,'o-_- ------------- Number of lines----------5.. --------------------Len ---- Type of filter material -- -- 1 ___ t D.e.pth of filter material--------AX---------Total length-----I----------------- --.- I Seepage Pit: Distance to nearest well--------____--------_Distance from foundation-------------__---.Distance to nearest lot line-----------.-_-.. I El ❑ Number of pits-=- ------t- ------Lining'material-- - - ------------Sizie: Diameter-----------------------.Depth---------------------------- ----- fram fountion- - ----------------Lining material GW Cesspool: Distance from nearest=well,---_-----------Distance _`,------I—_-----------------. imI gals.J - Depth - -- - ----- ---- -------------------- --Luid Ca acity-- Privy: . Distance from nearest well--.-----_---------------------------------------Distance from nearest building----- N• ❑ (Distance to near'est lot line------------------- - ----- ------------------------- --- ------------------------------------------------------------------ -- ------------ Remodeling and/or'.repairing (describe):-� -- ------- ------------------------------------------------------------------------------- t ! I ! f 1 ---------------------------------------------------------------------------------- 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 reqplafjons of the San Joaquin Local Health District. (Signed)_---- ---- k -----------------_--------(Owne)r and/or Contractor) ( ------------- Title (Plot plan, showing size of lot, location of sysfem•in relation to'welis,-buildings, etc., can be placed on reverse:side). f � , ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------- Z— -------------------------------------- DATE---------- �f REVIEWEDBY '-----------------=--------- ---------------------- ------------------------------ DATE- ` BUILDING PERMIT ISSUED------------------- --------------------------------------------------------------- ---------------- DATE------------------------- ------------- -------------------- Alterations and/or recammendafion`s:-------- _- 7 ------ - Y - -- ---------------- I - ---------------A0------W°'t �------ot�- "S-----, Gni-----. rr ------ ------ - ` -----•--- �� v ........ - -----A- --- ��-*� �- �'`- ' - --------- ..�� '- "�t�'"-''r� 1� �1 7 rpt -A--•-- =. 6,1t--------0. �- �ti2 6 FINALINSPECTION BY--------------------------------- -- - -------------------- Date------------ -------- ------------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Me. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockloa,California Lodi,California Manteca,California Tracy, California F.P.C 13.