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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ____.•------ .-------� --------------------- -------- --------------------------- (Complete in Duplicate) 9 Date Issued .._._.________-----------:.............__._______._._ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is.,made.,in_compliance with County Ordinance No. 549. 063 -- 2-&0,-10 JOB ADDRESS AND LOCATION--- rS Qd'_-`"` `='J Owner's Name-------W_c at---_-_. -- Address-----. ------ -�----- -- Contractor's Name------- ----------------- - r -------- --------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---4 Number of bedrooms _._ Nu mber aths _ Lot size ____-..113 .a- -±y___________________________ Water Supply: Public system ❑ Community system ❑ Privae Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z Hardpan ❑ Previous Application Made: {If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well___) - --Dista ce, from foundation-----/_0______._.Material._.___-�1 - - .____._____. No. of com artments_. ��_ Size_ _.__ _ ___ f _ r " � ___ r6- , P -- X� -Liquid depth Capacity.. v' � / r / Dispo I Field: Distance from nearest well ._-_..,✓._.. Distance from foundation------ ¢_ -__-iDistance to nearest lot Iine_._��___ ________ 1� r Number of lines----------5.3_.__________._____Length of each line gk_-_)V_____7A'Width of trench.___-�___----------------------_____________________ W� __.__De Depth of filter material_____/9_._"_____.-Total length_____�f4'__ Type of filter material-- -__-_- 'LR_? p Els Seepage 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-------------------------------------- Size. Diameter--------------------------------------De th----------------------------------------------------Li Liquid Capacity ❑ P q ----------------------------gals. Priv Distance from nearest well_____._._____. '" ____._Distance from nearest building ❑Y ---- ; --------------------- --------------- ------------------------- Distance to nearest lot line ----------------------- - -------- ---------------- F Remodeling and/or repairing (describe)-------------- --------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------ ---------- -----------------I------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- I hereby certify that I have prepa,�;�d this application and that the work will be done in accordance with San Joaquin County ordinances, StaLws, d rules and regulations of the San Joaquin Local Health District. (Signed)____ _________________(wand/or Contractor} --------- ---------- (Title) ------------------------------------------------------------ By: (Plot plan, showing size 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--- l-'f,3 � �--------------------------- -- - - --- -- - -- - -- REVIEWEDBY------------------------- ---------------------------------------------------------------------------------------------------- DATE----------------------------------- ------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DA-TE----------------------------------- - ---------------------- Alterations and/or recommendations-------------------------- - -- - - --- ----------------------------------------------I-----•--•-----...----•-------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ---•---------------------------------------------------------- --- -------------------------------------- -------- --- --------------- ---- -------------------------------------------------------•-- ------------------------------------------------------------------------•---------------------------------------------- ------------------- -- ---- FINAL INSPECTION BY:__-- -- _ -- - ----�.-.____s!------------------- Date---- .�_.�_3..~ _._ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sfackf*n,California Lodi, California Manteca,California Tracy,California F.a,c o.