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F ��1144 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - -------------------------------------------------------- �� (Complete in Duplicate) r This Permit Expires 1 Year From Date Issued 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. wry --r�Y- Y�--- '' JOB ADDRESS AND LOCATI a r-/-_ f T Owner's.Name----- Phone Address----------V_,or--F i t `"-•------------------------------------------------------------------------------•-------•---•-------•----------------•--••------- Contractor's Name---------- ------ Phone--------------- ------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 0 Number of living units: _/___ Number of bedrooms .r - Number of baths - ___ Lot size _________________-__.______ Water Supply: Public system ❑ Com;unity system ❑ Private Depth to Water Table X4 ft. Character of soil to a depth of 3 feeti Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9j-'1H%rdpan ❑ Previous Application Made: (If yes,dote--------- --- ------I No CIS New Construction: Yes [Pilo ❑ FHA/VA: Yes Zj�-- No E]- TYPE OF INSTALLATIOWAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ___Distance from foundation---A9------ - f Il' 4��' _---________--.--___._. No. of compartments-_- ..---------------Size!!Wk"�X�_,___Liquid depth__. ...___Capacityer"94 �`. -- - - --- -- -- i p n,2(,�__.______-Distance to nearest lot line_Z� Disposal Field: Distance from nearest wefi.�_.�-P- -.Distance from foundatio --- ------... y Number of lines_._._`________. ---_-_ Length of each line--- Width of Dtrench..e�..*________________---.-- Type of filter material�f` D�' _ epth of filter material___� _._______T � __ Total length_-__ ____________________ _______ Aor See age Pit- Distance to nearest well--/W --------Distance from fo ndation- p--------Distance to nearest lot line,/ -------- 00 Number of pits-../--------------Lining material_,��4�_--Size: Diameter .Depth_. --------- ------- Cesspool:r� Distance from nearest well-----------------Distance from foundation____- -___-.______.Lining material------------------------------------- s a ❑' Size: Diameter-------- --------- ------ ------------Depth------------; ----;----------------------- Liquid Capacity gals. P.rivy:: Distance from nearest well_______________________________________ ________Distance from nearest building ----___._.____-_..__..._.� ❑ ,, Distance to nearest lot line---------------------- - "------------ ------------ ------------=--------------- 9 a � y G Remodeling and/or repairing (describe}: ------ - ---- y% --------------------------------------- ------------------------------------------------------------------------------------I-------------------------------------------- f --------------------------•----------------------------------------•-------------------•------•___------- ............---------"•---------------------------'------------------------------------------------__-_ ________________________________________________________________________________________________________q____________--_-_--__________________--__--_________.----__.______________________._.___.._____-------____-_...-_ 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)------------------------------------------- [QwjvnPnT*or Contractor) BY:------------------------------------------------------------------------------------ -- - -- - - - �-------(Title)--- --- ------- -- ---- --------- (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- �✓/� DATE------ -7d7_6_6------- REVIEWEDBY-------------------------------------------------------- ------------------- ------------------------------ ---- DATE---- ------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----- -------------------------------------------------- Alterations and/or recommendations:------------ -- - -------- =---------------------------------- ------------------•------•----•-•-----------••------ ----------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------- ---- -------------=----------------------------------- -------------------------------------------------------------- -------------------------- -- -- ---- - -- - FINAL INSPECTION BY:---- -------- Date------- --- - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1`80.1 E.Hoxellon Ave.'++ 300 West Oak Street " ti 124 Sycamore Street 205 West 91h Street " STocklon,California Lodi,California Manteca,California Tracy,California se. — t F.P.C O.