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FOR'OFFICE USE: pa77_,�Z 0 - -------------------------------------------------------- � APPLICATION FOR SANITATION PERMIT Permit No. ---------------•--- ----------------- ------ (Complete-in Duplicate) 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. This application is made in compliance with County Ordinance No. 549. �� 7 ,,,� JOB ADDRESS AND) LOCATIO /N-4 � ��' ----------------------- Owner's Nam lTFJ�-.Q�------.4:h'Ic &�.+ Phone-----------•- ------- --- AddressQ---------- -�----•------------------141----------------------------- = Contractor's Name ,t%! " me*'------------------------- Phone ... Installation will serve: Residence 1P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other Number of living units: __L-_ Number of bedrooms _y--- Number of baths '.___ Lot size __/0_ __aPit_~- .-.-_--.-___------------------- Water Supply: Public system ❑ Community system ❑ Private ( Depth to Water Table Y-47 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M Clay ❑ Adobe ❑ Hardpan Qj 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 p ' p permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli_/Q'a'------Distancp from foLundafion_o;n�!-----------.Material - -------------------------- 2 ------------------------ No. of compartments._. ................... '_ - -P-- ------Liquid depth--.-%S7'------- --------Capacity.&----------- Disposal Field: Distance from nearest earest well,OVI-_.._._.Distance from foundation-3A-------------Distance to nearest lot IV Number of line's ---rA---------------------------Length of each line--/. ..------ Width of trench.- -�!�_`-----------------..- WV Type of filter matenal,�4,R_____------------Depth of filter material-./?."_...__...._Total length_,A.— ----._--._.-.-__---..-_-..-- Seepage Pit: _ (S Distance to nearest --------Distance from foundation... ._-.------ggistance to nearest lot line-l--.-. --- Number of pits--,Z --------- Lining material-- ------- Size: DiameterA_o; #_____---_ Depth-A ___________ �- Cesspool: Distance from nearest well _--------------Distance from foundation_.__........._._ -.Lining material---___-..___----_.----._-_.-___.-.-. .0 Size: Diameter--- -------------- ----------- ----Depth------ ---- ---- ---- -------- --------------------Liquid Capacity-------------- -------------gals. Privy: Distance from nearest well................v--------.-----....____-.-..--.-Distance from nearest building------------.___.____-___-_____-.._-_-... ❑ Distance to nearest lot line_______________._....._ Remodeling and/or repairing (descIribe):----- ----- ----- --------- ------------------------------- 11 -----------------------------------=-------------=--------------•-------------------------------- ----------------•------•----- --------------- -------------- ------------------------------------------ :i ----------•-------•--------------------------------------- --- ---•--------------------------------------------------•---------------------------- - - �E • . ------------------------------------------------------------'---------------------------"-------------------------------------------------------------------------""...-------------------------------------------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County Q ordinances, ate laws, and rules and re lations of the San Joaquin Local Health District. JA1 (Signed) , "ev - ccr -------- ----------------------------------------- - --- ----- - --- --------(Owner and/or Contractor) Y------------------------------------------------------------------------------------------------------------------------- --------(Title)---------- ------ ------- ------------- - ...-------------- -- (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-.IG..- REVIEWEDBY--------------------------- ---- . --- --- ---I--------- ------------------ --------------------------------- ---- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED `--------------- --------------------------------------------- DATE s-------- --------- -------- ----- ---------------- -- ------------------------------------------------------------ __ ------------------------- �1 ' Alterations and/or recommendation _ f ----------------------------•------------- - - ----------------------------------------------- -------------------------------------------- ----------------------------------------------------------- --------- ---------------------------- -- ------------ -----•-------------------- i -- ---------•----------------- ---•-------- ------------ ----------------- ---------- t. t FINAL INSPECTION BY:.,%_;;r4 - ---------------------_--. ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. �I 300 West Oak Street 124 Sycamore Street 205 West 9th Street r 519cktan,California a Lodi. California Manteca,California Tracy, California { "E.H.9 2M 1.67 Vanguard Press -