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FG; E USE: J/,-,;- ------------------per � /n__.-- 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 worn Pante with County Ordinance No. 549. / JOB ADDRESS AND LOCATION /�` ------------ OwnerOwner's 's Name--------------- --r-----/:f__:. - -------------- ---------------------------------- "9 L Address----------------------------------- -------------- ----------------------------------------------------- ---- Contractor's Name'_"--------- �%�./�'� �� . -•------------•--•-------•---------------------- Phone---1 fs'g11 Installation will serv�'"'Residence 0''Aparfmenf f bedrooms Number CommercialL] baths Trailer� Lot size._-�-1=w�c`?1��'--z`-�_F=---------------- Mofel C3 Other Number of living units. _._.____ Number o I Water Supply: Public system ❑ Community system ❑ Private 214epth to Water Table -40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0--<1ay ❑ Adobe ❑ Hardpan ❑-- I Previous Application Made: (If yes,date-----------.--------} No ®.-'New Construction: Yes 0/No ❑ FHA/VA: Yes ❑ No ®-, r TYPE OF INSTALLATION AND SPECIFICATIONS: (Na septic tank or cesspool permitted if public sewer is available within 200 fee+.) ! Septic Tank: Distance from nearest well__-._:__.-_DistanceP'from-ibundation_,_1�6_ ...... Mater al_._ I Q� No. of compartments------ 2_------...Size-1. »_'-6---:---Liquid depth.- 1 �el-------.Cape ity./ Disposal Field: Distance from nearest well -------Distance from foundation-/Z) A _____.....Distance to nearest Im --- ---------- EK Number of lines___..___:;_I_ ...............Length of each line,—,77 /-�Y__.Width of trench......�-E_-_..__...__._-__-__ Type of filter material_ 8�1'___._.Depth of filter material__Xee.`r.........Total length----/_�F_z9_`_____________________ f ©� I p � _ ____Distance from foundation__��__r-_.Distance to nearest lot iine__OpT__ ------ Seepage e Pit: I�lumabee of nearest el1- p�1 Lining material_-�// �1___.-Size: Diameter_ `�._.__.-.__Depth__..-. -15 -_/_-__.__._- Cesspool: Distance from nearest well--------- ----._-Distance from foundation-----------------_-Linipg material____..._______--.---_--___.-_-_..__.. ❑ Size: Diameter. -------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. y nearest lot line------- ---------- ---------------- ----------------------•------------------building- ---------- --------------------------� Priv Distance from nearest well '•.____.. .� oi:i----------------------Distance from nearest ' ` F Remodeling and/or repairing describe :_- --------------------------------------------------------•--------------- -------------- ----------------------------------------------------- ----- I'" �----------------------------------------------------------------------------------------------------------------------------------- ---------- -------------------------------------------------------I-----------------------=--------->---------------------=-------------- ---------------------------------------------------------------- - I hereby certify that I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County I ordinances, State and rules and regulations of the San Joaquin Local Health District. r *10 [Signed) /�� al---------------�� -------- -------------_--------- -------(Owner d/or Contractor) d � Title__-.,._ -_ By:---------------- ilii�Lrl -rte-- ----- (Plot plan, showing size of lot, locatia of sys+em in relation to wells, buildings, etc., can be placed on reverse side). 0 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------------------------ ---- DATE------ - /rJ- /' .:. - J -------------- - ----------------------- REVIEWEDBY--------------------------------- --------------------- -- ---------------------- --- - ------------------------------------ DATE-------------------------=---------------------------------- BUILDINGPERMIT ISSUED------------------------ -------------- -------------------------------------------- ----------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------ ---------------------------------•-•----------...._--------------•------------------------------- ------ --- -------------------------- �%l_its -- "`=----- 's`a••'--- - - ---/�e�"�; -�--} ----------------------- - ----------------------- - !o-iy-6 •° ------•-------------=--------------------------------------------------------------- FINAL INSPECTION BY:---------L_----------------------------- ------ '^ Date-----/"Or e-=- -- --------------------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California