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FOR OFFICE USE: --------------------- - APPLICATION FOR SANITATION PERMIT Permit No. �7�� ------ ----------- ----------- ------------------------- ----------- ------------ (Complete in Duplicate) Date Issued ------------------ This Permit Expires 1 Year From Date Issue 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. �A) 00']-- 05 0_� � 2 ,J- w 0u ST7.`j � f x.7..3.56 � ----- JOB ADDRESS AND OCATION ' Owner's Name ------ Phone - - ----------- -------------------- ► uc,,,,��Tt J- fiC �--aC/ 2 ------------------------------------- Address------- - -••-------------- � --; :- - � Phone.___Con#rector's Name Installation will serve: Residence [" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ y, r 3 a �/----- Number of living units: -A-_ Number of bedrooms _��Number of,baths _ Lot size ._---__-_.- -----_ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table ---_--.- ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel F1 Sandy Loam El Clay Loam ❑ Clay 0 Adobe E] Hardpan Previous Application Made: (If yes,date_-.- -- --1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No.septic.tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well----�t'."__Distant 6tom foundatio -! .............Ma-t--e--r-i-a--l-------.- - ----- _-----. No. of compartments----- YLiquid depth ----- ---------Capacity--f�ou. A� � Distance to nearest lot liner-.._---_---. I �- -------- Dispos field: Distance from nearest_wJa! .... ._--.-Distance from foundatio�_-� n th_-___--.-�..�-!!------------------------ Number of lines-_-.- �"----------------------Length of each line-_�-_----_--- material--.-----sS_/Z--.-----De Depth of filter material---_-fy...........Total hle of trench_ ..-- - d Type of fEI-ter p � Seepage Pit: Distance to nearest well----------------------Distance from foundation......--------------Distance to nearest lot line_-------------- --------- ❑ Numbet {from well material stance from foundation Diameter==--dining material�h--...�.. ------------------------ Size: -�f-------- ----------- I �� p g Cesspool: Distance --____ els. ❑ Size: Diameter--------------------------------------Depth_-'-------------------------- -----------------Liquid Capacity ---'-' ------ g « . Privy: Distance from nearest well--------------------------------- ---------Distance from nearest building-_.-_--.----r----f----_----------_----. ; ❑ Distance to nearest lot line----- ------------------ - ----- = ----------- u_4 ; Remodeling and/or repairing (describe:- _---- -- 1 ---,-------- -�------------------------------ l - -- ----- ->.-- • - ----------------------------------------------------------------------- ----------------- -----•- ------=----------------- --- ---'-------------------------------------- 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 Locai Health District. I , r _ d/or Contractor) (Signed)- --- ------------------ - - ----, --- ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. ! - - ----- ---- - ----------- ---------------------------------------------- DATE----6- -- - -�'f ----------- --- ----------- - -- REVIEWED BY----------------------------------------------- ------------------I------- -------------------------------------------------- DATE-------- -------- ----------------------------------------- BUILDING PERMIT ISSUED-------------------- .. DATE-----------------------"-------------------------------------- Alterations and/or recommendations----------- ------- ----------------------------------------------------- ------------ ------------------ --------- --------------------------- ---------------------------- - --------- - i --------------- --------------- ----------- e Date_.! ��fz.-.-.-- ----- FINAL INSPECTION BY:�_ ---- -- -- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5loektan,California Lodi,California Manteca,California Tracy,California