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FOR OFFICE USE: ---------------- -------- ---------------------------------- ---- APPLICATION FOR, SANITATION PERMIT Permit No. ----------------- ------------------------------- - (Complete ln-Duplicate) Date Issued r!711=_&A�� ------------------ ------------------------- --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a pei'mit to construct and install the work/erain de rib d. This application is made in compliance with County Ordinance No. 549. 4�a// JOB ADDRESS A LOC TION__._y---- ------ Phone_-__-._ -------------_------------ Owner's Name--------- Address--------------- ------------------------ ----------------------------------------------I.......... ...................... --------------------- Phone....._..------------------------_ Contractor's Name----------------- ---- --------------- -------- Installation will serve: Residence P3�Apartment House E] Commercial [] Trailer Court C] Motel 0 Other Number of living units: Number of bedrooms _,wf Number of baths J--- Lot size -_.'----------=---------------------- Water Supply: Public system E] Community system [] Private P""Depth to Water Table 49&_ 4" Character of soil to a depth of 3 feet: Sand Ej Gravel El Sandy LoamE❑ Clay Loam E Clay ❑EAdobe �Hardpan ED' Previous Application Made: (if yes,date-------------- No e New Construction: Yes E] No 0'" FHA/VA: Yes TYPE OF,INSTALLATION-7-A-ND-SPECIFI&TIC)NS----------�------- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ----------- Septic Tank: Distance� from nearest well jo..a Distance from foundation--AV----------Material-- I-- - ---------- - --- ------- Z No. of compartments-----1�-?---------------Size-AK'S66- "_`�Iqiuicl cl,pltk__;5;��!�............Capacity_zt;_:F?4�---- 01 / Disposal Field, Distance from nearest well.:J?."_Distance from foundation---la------------Distance to nearest lot line--- -----;F-- Number of lines----A------- ------- -Length of each linef W./---------------.Width of trench-.r2__._____...__________4--- Type-of filter maferial/4 Depth of-filter rnaterialA---'*----------Total Iengfh__A__j9.4?�------------------------- x I Seepage Bit- Distance to nearest well___!69 0 __Disfamee from f9undation__-,J__0--------Distance to nearest lot line___~-_____ —--------- ie4W?l Number of Lining material__, --Size: Diamefer._.2__-e;.4--------Depfh___S.� ___ - 131 ,VP Distance from nearest well---- ------------Distance from foundation_-----------------Lining material---------------I-------------------- p F1Si7e. Diamefer_i----------------Z----------- ------Depth------ ----- - ------------------------- -----------Liquid Capacity- - ------------------..--gals. Privy: Distance from nearest well-_______________________-_____-- -------------Distance from nearest building_____._.______________________..__..___ ❑ Distance uilding---------------------------------- Distanceto nearest lot line------------ ------ --------------_--------------------------------------- ------ -------------------------------------------------------- .OPP OF Remodeling and/or rep-airing (describe):-- _;ht - --- - ----------I------- i ----------------- _ W��4 44T t� r --------------------- - -- - ------------- ---------------------------------- ---- --------------------------------------------- ----------------------------- -- --------- ------------------- ------------- --------- Ya. ----------------------------------------------------------------------------------------------------------------------------------------------- ---------- - ------ 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 regulations of the San Joaquin Local Health District. r Contractor) . ........... .. ----- -----------------—-- ----- -- -- ------ .. .. .. ----------- ------------------------- ---------- --- ------------------- By:-------------------------------------------------------------------------- ------- ............. ---------(Title)...&-n-fl, k�__ (Plot plan, showing size of lot, location of system in r tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - ------------ -------- -------------------------------------- --------------------------------- APPLICATION ACCEPTED REVIEWEDBY---------------------------------------------------------------------------------- --------------_------ ------------ ----- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------- ----------------------------------------------------------- -- DATE----------------------------- -------------- ----------- Alterationsand/or recommendations:------------------------ ------------------------------------------------------------------------------------------------------------------------------------- --------------------- ------------------- -------- ----------------- ------ ------------------------------------------- ------------------------------------------------------I--------------------------------------- --------------------- ------------------------------------------- ---------- -------------------------- --------------------------------------------------------------------------------------------------------- ------- ..................... ......... ------------------ -- ----- --------- -------- ----------------------------------_--------------------------------------------------------------------------- ------------------ - - -------- -------------------------I--------------------------- ------------ ----------------------- -------------------- -------- ------ --- ------------------------ FINALINSPECTION BY...-- ----------- 2 ------------- Date-------------------- -------- ----- ----i- ------------ -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT' 1601-E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stacklon;,Cdlifornia_ Lodi,California Manteca,California Tracy,California F.P.00.