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FOR OFFICE USE: 1 4__.4,j7-------�--��..40&1- . - .---_-•-.----------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. J S--------- ------------------------------------------------------- (Comple#e in-Ouplicate) f // -------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued if I r7q- 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 madeTm compliant-e,wif ,County Ordinance No. 549. JOB AQQRESS AND�LOCATION- ,�`-"z_. 44� Owner's Name------- -------- ----------- •----- ------ ------`'-----==---•---- Phone------------- -----------------•--- 1 Address-----1------- -G'---- = ------ � _,S �— G 7 a'� = --------------------- • '. �f�, ----- -_F. --. ------------- Contractors Name---- 1'IF-------- ------ ---------------------------------- P hon - e � 02 Q Installation will serve: Residence Apartment House [ Commercial ❑ Trailer Court .�3 Motel ❑ Other ❑ Number of living units: ___/___ Number of bedrooms _t __ Number of baths _ _l._ Lllf ot size ---------------- A -__/.-� `__--__-_____ Water Supply: Public system ❑ Community system ❑ Private X Depth to. Water Table JW_ ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe ' Hardpan ❑ l Previous Application Made: (If yes,date.....................) N00 New Construction: YesA' No ❑ FHA/VA: Yes ❑ No,x TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) p Septic Tank: Distance from nearest well--- -/Distance from foundation._._l�_ --_.Mate iial------ ---------------------------------------G[� U No. of compartments--------�------- -----Size------. ---_------Liquid depth----- -------------- - --Capacity--Z f i Disposal Field: Distance from nearest well...4 ....Distance from foundation----lQ_.'___Distance to nearest lot line----§� __r1 x Number of lines----------v _-_-_- Length'of each line-------11/1 ----------.Width of trench __-_--_�_ _-_- --------- Type of filter material-_:- 4._--__..Depth of filter material-----Z9`fir___Total length_-_...._ l_`�a_`--------------- N11– - � Seepage Pit: Distance to nearest well__-� Q-..-.___Distance fro fou dation_-/C�_---------.Distance to nearest lot line---�___..._ XNumber of pits------.2- ___-__Lining material_-.-_--Af" -Size: Diameter.-_. __"r___Depth______-_tea_ - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-___.-..___.___-_____-_-----.__.. { ❑ Size: Diameter-- ------------ ------------------- Depth----------------------------------------------------Liquid Capacity-------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building_.________-____________--__.-_--__-__. ❑ Distance to nearest lot lire-------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ , ------------------------------------ -------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------- 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. ,w i (Signed)------------------------------------------------------ --- �--/ -------- � -(Owner and/or Contractor] By:----------- u ------------------------------------------------(Title)--- ---•-- --------- ---•-- ------. .---..... ......... (Plot plan, showing size of loft, location o ystem in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY t t APPLICATION ACCEPTED BY--------- Y C = ------- ------------------- DATE.--------- --- ------- ---------- 66� REVIEWEDBY------------------------------------------------------------------------------------------------------=-----L----------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------- -- ---- DA•TE.------------------------------------------------------------ 4 AI#era#ions and/or recommendations:__-____._.:. --- l a` � ------------ / ---------------- �' ----------------- ------------------------------------------------------i!---------------- ---- -- ------------ --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:. - Date_L.. _ �r^ SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 F.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California r J