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FOR OFFICE USE: u 1 ` ------- ------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. .. ......... . ..:... --------------------- - (Complete in Duplicate) - ------------------- This Permit Expires 1 Year From Date Issued -- -- --------------- -- Date Issued ---4- --- ------------ 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 30N pli nce with County Ordinance No. 549. �CALVAJ sd� JOB ADDRESS AND LO 11 �YY1-'L� �-' Owner's Name----------- ------- Phone _TS 5G ------- ------- Contractor's Name O-Q ----- ------ ----•-- Phone------------------------------ Installation will serve: Residence [Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _C_-.--- Number of bedrooms 3__ Number of baths ---1___ Lot size _-IgG ------------------ Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table YO ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Cay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: llf yes,date-. No New Construction: Yes �o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Set-c T nk: Distance from nearest well---S.Q----_Distan e ,rom fqu dat_ ion--.--� .__--__M terial-.-CS CR- -T -_-----. P No. ofcompartments-..-_.: ..._---- Size-- ;�'X1 -�, -- -Liquid depth_- -Z,�-- ._Capacity../��___ Disposal Field: Distance from nearest wef1_50._._-:Distance from foundation.-_ line---- Number ` IJ �Q---------.Distance to nearest lot line.__5--------. Number of lines----2---:- _--__--___-__Length of each line.100rf--- �-.--.Width of trench.-.- Type of filter material-_fiQ_ K,____-Depth of filter material.--- length-------------------!�� ,'t Seepage Pit: Distance to nearest well----__---------------Distance from foundatio5 -/mm9.......-..Distance to nearest lot line -------- El '--❑ Number of pits.-------.--_-----_-.Lining material--------. .Size: Diameter-----------------------Depfh-.--..._---__.__-------__ Cesspool: Distance from nearest weVl______ _________Distance from foundation___.-..---.:__.____.Lining material-.-..-....-.- ---.-: ❑ Size: Diameter- Depth---- ----mmmmmm--------------- --------------Liquid Capacity- Privy: apacity Privy: Distance from nearest well--------------------------------------- _...Distance from nearest building_--....-------.----.-_---------_-__-___ ❑ Distance to nearest lot line ------- -------- ---------------------------------------------- ------- Remodeling and/or repairing (describe):__. �Q oF- ,ta1YL 15_- .l9-'. �nl � .PTH womola t�114- ------ y --------- ---- TL-R.Q--•------ ------- - --------M -------- 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, an rules and -regulati of the n Joaquin Local Health District. -- - ...-- . (Signed)---------------------- -- ----------------------- -(O and/or Contractor) $y:--•------------------ ---------------- - --- ---- ------- ------- (Title) (Plot plan, showing size of lot, location of system ' Iatian to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- ---- ----- DATE-------------------- - REVIEWED BY------- --------- BUILDING -------BUILDING PERMIT ISSUED.------ --------- DATE----- ----- Alterations and/or recommendations: 4.b-7..7 oL6.---------- ------ -- ------ ------- -------- ------ ------- ----------- ----------- ------ ----- 1 , FINAL INSPECT -- Date_._. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stackton,California Lodi,California Manteca,California Tracy,California F.P.CO.