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i=os2 OFFICE;USE. - Permit No. e{� . ----' -7,,- -- ------------------- APPLICATION FOR SANITATION PERMIT ...------------ -------------- - [Complete in Duplicate) - . __________ _____:............................. This Permit Expires 1 Year From Date Issued Data issued _- �r—_P Application is hereby made to the San Joaquin Local Health Dist ricf for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No. 549. JOB. ADDRESS A ac oN�i ------� ---__.'_. -._.. _�-_�..�•�� ' owners Name--------------------- -- ----- - •. --- ------- -- ....----- ---------- Phone...... - - .... Address............- . _ ....... - •._ ...�._. _�__..._..._---- _. Contractor's Name---.----- --•. _ -.._. ...__... ...... -•-•---.....-�. Phone....-------•--..........------•- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ other Number of living units.: Number of bedrooms Number f baths ._�__ Lot size _.._ �... _-... _�.__._.._ Water Supply: Public system ElCommunity system [IPrivate Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam El Clay Loam ❑ Clay ❑ AdobeZHardpan ❑ P Y 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.) Septi ank: Distance from nearest well_ r Distance,fro foundatio ..___.L. ._r.-Mat ial....... . ...... .No. of compartments_-_--`?�----.��.Sixe_�y__.,��..'...X� quid depth------- -._�..........Capacity...�' 4 s Dispos Field: Distance from nearest well....��._..._.Distance from foundation.....//__—_..Distance to nearest lot I� Number of lines........../------. Length of each line........ ..................Width of trench._..- .._.. ^, r s Type of filter material---------�.v_�._________Depfh of filter material.._._�_�_-____._Total Distance to nearest well....../__00..�..Disfande from foundation___ iitance to nearest lot line- El Number of pits........ ... .--Lining material__.... li' a___-Size: Di ,/Dep ................r Cesspool: Distance from nearest Distance from foundation___-_._------------Lining material..................._..._......_..... ❑ Size: Diameter.--------------------:.............Depth................. ..__.- --------------Liquid Capacity-••---•----------------...gals. Privy: Distance from nearest well...... ................ from nearest build ing.......�_._... ❑ Distance to nearest lot fine.-...�_. - --------------------------------------------------------------=-----------•-•---------•-•----------------• 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, Stat s, and rules and reg ion of the San Joaquin Local Health District. (Signed) - ------------------------_-----------------------•-----..-.---------�}er and/or Contrattor) tTi}fe)............................ (Plot plan, showing size of lot, location of systerri in relatio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY IF APPLICATION ACCEPTED BY--- ........ - - - - DATE ~I, -- ......... REVIEWED BY-------_-----_-------•.............................................�.�.-.-..__T.-..�.------------------ DATE--..................._.-............... - - BUILDINGPERMIT ISSUED-_-------------------------- _......... ._.._.................. DATE._—.._-.--•-------------.... -- ,_ Alterations and/or recommendations................:_-.---------------- --•------ --------------...........:.......... _.._.......... _..................... _ I� FINAL INSPECTION BY:...... .. .. ._ _ - --...............-- . Date------ --- ----------..__. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 IF.N"etwo Ave. 300 West Oak Siraet 124 Sycamore Street 205 West 91h Street ilo0don,Coliiornie Lodi,California Monteca, California Tracy,California F.P.0 o.