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1Q 1d�� APPLICATION FOR SANITATION PERMIT Permit No. __ ----- ----- (Complete in Duplicate) Date Issued 1 € 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.kw JOB ADDRESS A LOCATION------- --=---------- -------------- ------ Owner's Name--------- Y Phone--------------------- -- ``` -------•------------• --------------------------- Address *, Address----=----•----- �" - ---------- ------_ -------- -------=--------- ---------------------------------- ----- Phone«&-----!_"-" �� Contractor's Name_______________ i Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ y - ' Number of baths _J__-- Lot size ____-._ _ Number of living units: -------- Number f bedrooms _ 1 Water Supply: Public system.A Co`mmu lity system ❑ PrivateLi Depth to Water Table"-, -0 ft. Character of soil to a depth of 3 feet:I Sand ❑ Gravel ❑ Sandyl oam ❑ CIay�Loam ❑ Clay_.❑ Adobe K Hardpan ❑ _-� Previous Application Made: Yes ElNct� New Construction: Yes E] No K FHA/VA: Yes E] No ❑ T TYPE OF. INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest wel__ _-__ isant from foun anon__ Material----------- ----------" -�� i uid de th--------------------------Capacity-•------------------- No. of compartments-------.�__�-�-----}Size-----,1____---__ - - q p• Disposal Field: Distance from nearest well_______ ________.Distance from foundation__________-----__:_ Distance to nearest lot line_______.______.. ❑ Number of lines-------------------------�-----=Length of each line-----------4--=--•-----------Width of trench-----------------`------------ ----- ----Tota4 length------------------------------------------ Type of filter mafieriaL__ -----__j___._Depth of filter material----..s____:___` S .Nr. '..ae. .i f �_.:__-_..Disrce to nearest lot line__>~.1 ,�..�t}istancg�ra foundation . ��''��"'""""""'''"' �V-f - Seepage Pit: Distance to nearest well _ - `,f Vii, Number of'pits___.._}-.__�._ _---Linin material ze: Diameter__L ___-____Depth__- ._ _ Cesspool: Distance from nearest we�_____._-Distance from foundation__-"................Lining matenaL______________-__.__..._-__________. ❑ Depth ------------------------ =--------------------Liquid Capacity------- •gals. Size: Diameter-----------i- ----- -- F- -----------Distance from nearest building------ ---------------------------------- Peivy: Distance from nearest well--------------------------------- - Distance to no lot linen-- ----------- ---- -- ---------------------------------------="------•---------- ------------ ----- -- ------------------------- -- El Remo ling and/or rrepairi g escribe 1 _ Y _---•--_ --------------------------------------------`__•_•------•-- - ---------------------- __ -7 _- _______ _______________________________________-____ ___________-__-______--___________________________-.__________-______________-_______--.__.-___________---_---------------------- -------------------------------- ____..__�-___________ _ ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County F ordinances, State laws, and rules and regulafions of the San Joaquin Local Health District. t ` -(Owner and/or Contractor} (Signed)_ -------- ' Y ------------------------------------------------------ y e { ----- Tifl9................................................................ By:___-- -- --- --------- -• - -- -----------•- - -- (Piot plan, showing size of lof, location of s`stem in relation to wells, buildings, etc., can be placed on reverse side}. t FOR DEPARTMENT USE ONLY -------------------------------------------------------- DATE---------------- ----------------- -------------- REVIEWED BY----- ----- -- ------- -- v + _ DATE--- c. ' APPLICATION ACCEPTED I3Y____._ - S�IILDiPG PERMIT ISSUED-------------- -- ---- -------------------------------- ----- DATE-- --------------------------------------------------------- Alta at+a sand/or recommenda+ion : -------------------------------------------- --------••--------- . J ' � . . -- - '---=--- ` ---------------------------- t .... Date. - �y�~1 7 ]� - FINAL INSPECTION -BY:.__-1"S:._;-�-�--.- -- - ---�-y�=�'"----=--= - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stack+on, California Lodi, California Manteca, California y �1 ES-9-2 M Revisea 1.57 F.P,CO. �