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R OFFICE USE: ----------------------------------- Q2 crb APPLICATION FOR (SANITATION PERMIT Permit No. _ 7 - --------------------------------------------- --- (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 ermit to construct nd install the work herein described i This application is made in compliance with County"Ordinance No. 549. JOB ADDRESS AND LOCATION-$�/c_---------- -------:—r�� ------------------•--------------•----....------------------------------. Owners Name--"wuc> �• --------------------- Phone__ ' Address..........----------- ------------------------------•---------------------------------------- ------------ / Contractor's Name-----: ame ...... ................ --- ---------------- Phone../r4& -7.------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number.of living.units: _T- Number.of-bedrooms .' Number of baths ___L-_ Lot,size ------------------------ Water " ---____"____.______Water Supply: Public system :❑ Community system ❑ Privat �'4 Depth.to Water Table `I41_ ft. r Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ AclobeRr Hardpan ❑ Previous Application Made: (if yes,date---------- ] No rZ, New Construction: Yes ❑ No k FHA/VA. Yes ❑ NoA r TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic +ank-or cesspool permitted if public sewer is available within 200 feet.) Sep Tan Distance,from nearest well------------------Dzistance from foundation____________________Material_-__-__---___--__-_ _--___.-__`---___-. No:;of compartments______________----_---__Sie________----""___________.___--Liquid depth---------------- ---------CaacitY----------------------- Disposal ---- - -- -------Disposal Fief Distance from nearest well"._.lo.4�'-__.Distance from foundation"_". O_'____.Distance to nearest lot line---YQ'..... Number of lines____________1---------------------Length of each line_______PLO-------"_-___.Width of trench________ `f ry-_.-- ___.--_ Gcc� Type of filter meteiialt r_ 6 ' ____Depth of filter matenial______�d-''__.____Total al .length______________ _____------c1_'_____._ Seepagg,P),f:} Distance--to nearest ' Distance from foundation____9 .r."___.Distance to nearest lot line____`��_�___. D Num)jer�of pits_____.,�__.._.____Lining material . D�IC_Size:Diameter------- , ----------Depth-------. c5=____________-..� I- _— 1 Cesspoo : Distance from nearest well..................Distance from foundation--------------------Lining material--------------------------"---------- Site: Diameter---------------- --------•,Depth_=------ ----'=------------------- ------•-----Liquid Capacity-_------------------------gals. Privy: Distance:from.nearest.well______________;--------------.---------------------Distance from.nearest.building-------------------------------------------OPO ❑ Distance to nearest lot line--- -----`----------------- ---------------------------------- ------ ------------------------------------------------------------ ---------- 0 w Remodeling and/or repairing (describe):_____._ _ _ _ _._ 4'_______ _____ __ _ _ _ _ � -----._------------------------------- -------------- - t ----------------------------------- ----------- --------------------•--------------------•-•--------------------------------------------------------------- -------- --------- ------- ---------- 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. {O ner and/or Contractor) By:._---------•---fit G - Wit --------------------------- ---------(Title)-- - ------ ----------- ------------------ (Plot plan, showing size of to+, location of systerr(in relation to wells, buildings, etc., can be .placed.on reverse.side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------ - ----- -=------- ------------------ ------------------------------------------- DATE------- ---�_"'_�- REVIEWED BY------------ --------------------------------------------------------- ----- - --- ----------------- DATE. = = ----------------------- BUILDING PERMIT ISSUED----------- i 3 DATE----------------=---- - "--------------------- --•- -------------- --- -•----- Alterations and/or recommend;+ions:----------------------------------------------- -- - - �`-� --� �k-f------- ------- -------'--'-------------------- ---_---------=-- ---------------------------------------------------- - € ------------------ --- • ---------------------------------- ------------------------- ------------------------- ----------------------------------•--- --- -----. ---------------------------- ------------------------------_------------------------------- -- - . --------------------------------------------------•- ----------------------------------:--------- FINAL INSPECTION BY:. c'c�°-'. - -------- - Date.------- -f�Y- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tfaielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slockton;Callfornia�_Lodi,California Manteca,California Tracy,California, 1 ES 4 REVISED 8-59 3M 3-'63 F.P.CC. - 1N5