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FOR OFFICE USE: ----------------------f--r- Permit No. n� G7----------------- -- APPLICATION FOR .SANITATION PERMIT (Cornple*a-in Duplicate) f--3------ --- ----------------------- ---- --- ---------- ---- --------...- -- 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.------0).- .4� -----------� r•------------�------------------------------- ---------------------------------•------------- i Phone------ ------ -�----- �-- -- -- - ------- Owner's Name_____.______ - -••----...--- ----------- Address-----•--------t17.a_ ` �------- _y..__ ----- ---------------------------- ------ -------------------._...--------------------------------•- Contractor's Name------ -----•-----•- -------- ----- Installation will serve: Residence A Apar ment House ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ -__ Number of bedrooms a--_ Number of baths __/... Lot size ____. �'1- --roo' a /-- Water Supply- Public system Community system ❑ Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ - Clay ❑ Adobe x Hardpan ❑ Previous Application Made: (If yes,date....------ 1 No'A New Construction: Yes ❑ No k FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) Septic Tank:, ....9 Distance from nearest well-----------------Distance from foundation---------------------Material ❑ "/_y/A/6No. of compartments------------------------- Size-------------------- ------------Liquid depth---- - -- ------- ---- Capacity.. --- ---�- a Disposal _Field: Distance from nearest welL,Sf�_'_._Distance from foundation___ ___4"'-.______- Distance to nearest lot line____ -------- I Number of lines --------- Length of each line_- -- �_.�...__-.-.Width of #ranch-_-__et�rl` ---------- 9 Q ' Type of filter matenaL_-�+ --.--Depth of filter material _Total length le r Seepage Pit: Distance to nearest weIL1OW--------Distance from f undation__f0-__.__-_.Distance to nearest lot line__. _______ ,�,e ---. Size: Diameter.__-,7--`�---Depth-----p1�_r �r7` Number of its... _ Linin material_ . P �--------- g T Cesspool: D'stance from nearest well ________________Distance from foundation_-.......... .---_ ..Lining material_-._______---._____---.________---._. ❑ Size: Diameter- -- --------- - ----..Depth- ------------- -------------------- -----. -------Liquid Capacity- -------- -----------------gals. - - Distance from nearest building Privy: Distance from nearest well------------ - ---------------- - ❑ Distance to nearest lot line ----------------------- f� --- -------------------------- Remodeling and/or repairing (descri4ae):---- -------------- ------------ --------------------------------------------------------- ----------------------------------------- --------- - ----------------------------------------------------------------- -------------------------------- I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. (Signed) ------------------- - ---.(Owner and/or Contractor) By: �Y ---------------(Ti+le)-------- ------ ------ I (Piot plan, shaving size of lot, ca+ion of sys+ in relation to wells, buildings, etc., can be placed on reverse side]. 1 1 F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ---------- ----- -------------- ----------- -------------- DATE 6."'�vr ---1 � l REVIEWED BY DATE--------------------------- --- -------------------------- .._..- - -------------- ---------- ------------------------ BUILDING PERMIT ISSUED-------- -- --------------------------------------------- -30-_07 -------------- ---------------- ---------- - DATE I and/or recommendations:__M.. �5�.' -------- �f ------- /Zh'�.'---••------------- ----------------- Alterations .-------•-- ------------- ---------------- ------------------------ - . ----- �"� FINAL INSPECTION BY:..._:._ - --- -- �� ------- ------- ------ Date-------/ - - -- --------------------- ---------------- �� , AQUIN LOCAL HEALTH DISTRICT 1001 E.Ma=ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5lockton,California Lodi. California Manteca,California Tracy,California x i E.K.9 2M 1-67 Vanguard Press