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OFF CE USE:, -- ---- ./ � APPLICATION FOR SANITATION PERMIT Permit No. - -- ----- 11 - -- --- - - _ Com lete in Du licate �, _y . - �_ This Permit Expires l Year From Date Issued Date Issued _, _ �3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein descried. ash ' This application is madl��,in compliance with County .Ordinance No. 549. ] a- - ' JO ADDRESS SAND L-OCATION----�-�----- -------- Q- / -c1 Phone-------------------=----•---------- Owners Name-----,_-- - -- -•----- =i--•--•------ _ ---�-/---• --- ------------------ - Address-------•--------------_---. : ..�� -------- Owner's Contractors Name ------------•-•------ Phone..__.... Installation will serve: R partment House ❑ Commerci@@I E] T,1yiter Court Elotel ❑ Other [) CASE Number of bedrooms -------- Numbero ,ball , ._:Z of size Number of living units: _0e --------- 1 6 _X_(S'I, ------------------- If Water-Supply: Public system Community system ❑'IPrivate.❑ bepth fo Water Tabie ±r� .,ft. € Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay,❑ Adobeardpan Previous Application Made:k (If yes,date-- ---- ---------) No ❑ New Construction: Yes ❑ < FHANA: Yes ❑ No 9� TYPE OF INSTALLATION AND'SPECIFICATIONS: (No septic tank or cesspool permiffe�d if public sewer is available-within 200 feet.) { "' J F 1 r Septic Tank: Distance from nearest well-----------------Distance from foundation___,_,_____---.Material L.L�-�� C_A ----.____. r t nce from nearest we�__.__,__---__ Size_.�?t.��L�.f� Liquid depth.__:.�-.�....__.____Capacity_G1.Y�_:_� I No. of compartments._' __._ " T4 ------- Disposal Field: Dis a TV ( Disfance from foundation. u_ -_------Distance to nearest lot line-S-7_---_____� Number of lines----____ - Length of each line__ F j ' ��-�--�-------..Width of trench. -- --:�------------------ Type of filter material-J/_ r4 4q_�Depth of filter material �� - Total length._.. ------— ____________ /� Seepage t: Distance to nearest well----------------- ---Distance from fou dation . ----------Distance to nearest lot liner-_._..-.- ( oC- 5ize: iamoter___ De th-__qi— Number of pits.----Zl_______Lining mate naL_.Y 1(-; _ r 3 - P Cesspool: Distance from nearest well-----------------Distancle from foundation.-._r--_ -.__---- Lining material--------.-___-.---_.--____._--_--- ❑ Size: Diameter------------------------------------Depth--'.-------------------------- ---------- --------Liquid Capacity----------------------------gals. e � l! "Privy: Distance from nearest well------------------------------ ------------------Distance from nearest building-_-_---___-_ __.---_-__---..__--.-_... ❑ Distance to nearest lot line----------------------------- - -- ~ - t Remodeling and/or repairing (describe):------- � _ "---- •��-`�-.- --------------- -•----------•-•--------•-••-------------------------------------- ---------,------------------------------- --- - ------------------------------------------------------- - ! ------------------------------------------------------------- --------------- I hereby certify t ! have pr ed this application and that the work will be done in accordance with San Joaquin County ^ ordinances, State la s, d rules d egula 'ons of the San Joaquin'Loca! Health District. (Signed)______________ ____�..-_ _.__.___ _ and/or Contractor) Sy:----------------------•----------• - -- ------- - - ----------------------------------(Title) e..-.--.(Owner -------�----- i5 # f tan showing size of I , ocation of system in relation to•we S, buildings, etc., can be placed on reverse side). (Plot p g Y FO DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY .70 -_�rx 'Z"'r---- ------- ------------------------------- DATE---------------------'"----�---------------------------- REVIEWEDBY--------------------------------------------------- --- ----------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ---------------- DATE------------------------------------------------------------ Alterafions and/orrecommendations:---.Z.'_'-., ..--------�� }_tt:5*_ kA---------�� .-----•------0.--`-- 5-------------------------------- -------------------------------------- - • - -----------------------------------------------------------------I------------- ----------------------------------------------- ---------------------------- -----------------------------------------------•---------------------------- ----------------------- - r FINAL INSPECTION BY:---- '.. -s---------- -------- ---------- Date.. �' (P' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stotkfon,California Lodi,California Manteca,California Tracy,California ES 9 REVISEO B-59 3M 3-'63 F.p.CO. -