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FOR OFFICE USE: j & A�--------------------------- Per - ----J ------ APPLICATION FOR SANITATION PERMIT mit No. .1;2 -------------------- --- --------------- ---_--- (Complete in Duplicate) Date -Issued ---------- - - This Permit Expires I 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. 4 This application is made in compliance with County Ordinance No. 549. Z_ers— d��."10 10(� - --------- _dtl JOB ADDRESS AND LOCATION ----------- ------- -- --------------------------------------------------- ---------------- ------ Phone------------------------------------ Owner's Name -------------- ------------------ -- -------- - --------------------------------------------------- ------ -----------------'___ - --------------------W 9— C7 , /-----4--------------------- Address_-------------------- 57-1 7�------ 011. - :y ...... Phone.. Contractor's Name----- &a-------Tl "- - -4------ --------W Installation will serve: 'Residence E] Apartment House 0 Commercial C] Trailer Court A Motel [] Other E] Number of living units: -Z/.- Number of bedrooms -_Number of baths ----��Lot size ---- --------------- Water Supply: Public system F1 Community system 0 Private ' Depth to,r Water Table _460 ft. Sandy Loom El Clay Loam [] Clay [:1 Adobe)( Hardpan 0 Character of soil to a depth of 3 feet: Sand E] Gravel [] Previous Application Made: {If yes,date-----------------__) No New Construction: Yes Ck No E] FHA/VA: Yes E] No TYPE-OF' INSTALLATION AND SPECIFICATIONS: (No'septic tank or cesspool permitted if public sewer is available within 200 feet.) fion__ ..........Material----- ------------- Septic Tank: Distance from nearest well-__ d0-----Distance from'founda - -/ - ----------Size1�2_)(4 u .........Capacity-_Z2 q4?" No. of compartments----- X-6----Liquid Liq 'id.dep�h_.,____._C _ >; 1 /0.........Distance to nearest lot line-.Is----------- Disposal Field: Distance from nearest well... Distance from foundation _&k I--------------- Number of lines-------..- ----------------Length of each lire-------9,i�__�--------Width of trench----- Type of filter m .6 --/E' ----Depth of filter mate ria -Total length__,?-a -- -- --- --_._---Distance from foundation---/ Seepage Pit: Distance to nearest wel l- 10------ Distance to nearest lot line ------- o,i Deptk__..c�, -- -------- -------------------- Number of pts.... &---------------- _-Lining material___tf I Size: Diameter__.17j__ V) Cesspool: Distance from nearest well---_---_---.-.--Distance from foundation-----------__.---- Lining gals.material___.----..--.__-.-..- --__- _-- ---- --------------------------'Liquid Capacity-.. --------- -- -- - Size: Diarneter---- ..Depth-- --- ---- -------------------- Privy: Distance from nearest well.------------------------------------------------ is ante from nearest building -------------------- F1Distance to nearest lot line--------------- --------------------------------------- ------------------------- ------------------------------ ------------- 5_ Remodeling and/or repairing (describe)------------ -------------------------------------------------------------------------- ------------------------------------------------------------------ ---------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ------------------------ d ----------------------------------------------------------------------------------------------------- ----------------------------------I----------------------------------------------------------------------------------1. -------------------------------------------------------------------------------------- -------------------------------------i------------------------------------------------------------------------------------------- ----- 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. (Signed)---------------------------------------- pt----------- ---------------- ---- --------------------- ------- ---------------- -----------------------(Owner and/or Contractor) By:_-------0-------- 6- 1_441 --- ------- - -- ------------(Title)-------- -- ------... ........... 0 . location 00to (Plot plan, showing size of lo , ocation of syKsfe:rin Aft wells, buildings, etc., can be placed on reverse side) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------___-- - . .. ....?-- - ------------- ------- DATE-.---( Z REVIEWED BY DATE-------- -------- ------------------------------------------ - - ----------------- BUILDING PERMIT ISSUED---------------------- -------------- -----------------------• --------•--------------------------- DATE--------------------------------------------- --------------- Alterations and/or recommendations--- --------------- Id ------------------------------------- ---------------------- ------------------------------------------ --------- ----------------------------------- ------------------ I.......... ............. - u��-------------------------------------------------------------------------------------------------- ----------------- - ----------- - - - -------- ---------------------- ---- ---- -- :_ - ----------------- - ------- ------------------- ------- ---------------- ---------- -------- -------- ----------------- -- ------------ FINAL INSPECTION ------`!!�v---- -----C---------- Date........ SAN.JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slocktan,California Lodi,California Manteca,California Tracy,California