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FOR OFFICE USE: -7J� 9a C. APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------- ----- --------- --------------------------------- --- (Complete.in.Duplicate). This Permit Expires 1 Year From Date Issued Date Issued _ ___- :. .� ..... -Z3 dr-oho _07; 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 complance with.County Ordinance Vo. 549. JOB ADDRESS AND. ION. = ------ -------------------- ----- -•-- Owner's Name______ _____ �� i -------------------------- ---- ----------- hone-- -----------------•-•-- Address ! �� -5 ----------------------------------------- Contractor's Name--------------------------------`-( f --- ----•-=----------------------------- ------- ------ .Phone------------------------•--------- r Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer .Court ❑ Motel ❑ Other ❑ Number of living units: _--' ___.Number of bedrooms _5__ Number of baths __9-_-'_Lot size10___Q___________________._ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table t _ : Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes No ❑ FHA/VA: YesQ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub[ Se er ' a ilable within 200 feet.) - Septic Tank: Distance from nearest well--- !Disld;.p�`f�o fp ndyatiM tL___ _ ____ ________ No. of compartmerits_..__.__.____.._Size__ ..11-- /ILiquid depth_: __ ________Capacity_.(-_` _ __ Disp sal Field: Distance from nearest well__ _._._Distance from found tion__Z0__:_gdistance to nearest lot line Number of lines_ _________ Length of each line 49_`_ f1_�--/lNidth of trench._ r"r-� -- Type of filter material__,�r�� Depth of filter material_____l_�__!_�____Total length___, _ .. ------y Seepage Pit: Distance to nearest well-------.--------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----•------------------Depth-_-----------------•---------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________---________._____-__________. Size: Diameter--------------- ---------.Depth ---- - --------------I--------------------- ------Liquid Capacity ---------- gals. -� _ _moi - w� - Privy Distance from nearest well______. .__--__-- _______ _______ _Distance-from nearest building_____ ❑ Distance to nearest lot line----------------------- -- ------- ------------ - --- ------ ------ --------t -------- ------ ---- -- Remodel' g and/ r repairing (des tribe): �� ` � � ke - ------- - - ------ --- ---- --- --- - - --- ---- ------------- ------- �- - ----------------------------- hereby certi that I have prepared this application and that the work will be ne in accordant th S� J �. ,RaqCo ty J or finances, Sta I s, and rules and regulations of the San Joaquin Local Health District. (Signed)-- B4 - - ------- --- - -- -------- -------------------- (Owner and/or Contractor) By:------------------- ---- ---------------------------------------------------------------------------------------------- - -----(Title)--------- ------------------------------ ---------------------- (Plot ------------ ------ (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--- --- REVIEWED BY D --- ------------- -- -------- - --------------- BUILDING PERMIT ISSUED-------------- ------------------------- - -- --- Alterations and/or recommendations:------------------------------ ' �--`Sy -------------------------------------------------------------------------- --- - _- ---=----------------- -- - ------------ ------------------------------- -----------------, FINAL INSPECTION BY--------------- --------- - ------------ ----- Date--- --- r ��_� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Are. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockfan,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3•'63 F.P.CC.