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R OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.4. ..!�!_- / ------------- --------- ' ��' (Complete in Du licate p j Date issued ----------- ------------------- .`._�:'L -- -------- -- This Permit Expires 1 Year From Date Issued ------------------ -------- I Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------- I- Owners Name_ ____ ___________ Address a.rte-`-4s _1.1-x_ `. one -- - '------------ Ph --0��2� Contractor's Name-------------- �f `--`-"- 4 Installation will serve: Residence% Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 4 ❑ 1 "� ' Number of living units: ---1--- Number of bedrooms _''�---- Number of baths ----I--- Lot size __ ' ---X-�- -• --- ----------------- - Water Supply: PubltCommunitystem Private El Depth to Water Table -60 ft. Public system )f system �ravel Sd Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C]Character of soil to a depth of 3 feet: Sand ❑ G ❑ any Previous Application Made: (if yes,dote--------------------) Non New Construction: Yes ❑ No,P�r FHA/VA: Yes ❑ Nol' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public sewer is available within 200 feet.I Septic Tank: Distance from•nearest well-----------------Distance from foundatin --- de th_.Matersal:. - -Y Capacity____-_.__ -___--.---- ❑ ,.a� No. of compartments--------------------------Size------•------------------------LiquidP. Distance Disposal Field: Distance from nearest well---------------Dengnh ofrea linefound------------------------------ E] Pion------------- -W dth oftfrenchest lot line----_:-----_----- ❑ qqi� j Number of Imes_____ _ _ - - �f` Type of filter material-------------------------Depth of filter material-----------------------Total length___-.-----------t li -- -' f Seepage Pit: Dis#ante to nearest well-_-14 '._-_Distance from foundation___-__ Distance to nearest lot line-r ------• O Liningmateridl�.�•�r _,/,----Size: Diameter------ ---Depth �3 1A 0-PS Number of pits--------/------- - ing erial------------------------------------- Cesspool: ____ Cesspool: Distance from nearest well-----------------Distance from foundation-.------ Li+nuid 'Capacitygals. ❑ ---------Deth---------------------------------- --------------- q Size: Diameter-------------------------- - P Privy: Distance from nearest well________________ ________ ------------------------Distance from nearest building------------------------------------------ ----------------------------------- ---------- ------------------------------------- ❑ Distance to nearest lot line----------------- - --- ----- - ----------------- Y - --- 1T Remodeling and/or repairing (describe:-_._____. - f� --------------- --------- ---•- hat the wor done i I hereby certify thatI have esandregulationsthis ns application the San Joaquin L calkHealtheDistr ctn accordance with San Joaquin County ordinances, State laws, an -(Signed) - _(Owner and/or Contractor) -- - - -.r-- - 'r ------------------------------------------------------------------•------------------ SY� - ------ ------•---------------- (Title)--------- �------ -------- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY ; APPLICATION DATE------ ----G_ 1------•----------------------- ACCEPTED BY-.-____�-�----- � ------- DATE--------! ---------•--------------------------------------- BUILDING --•---------------------------- ---- REVIEWED BY---------------------------•------------------ -------- ---------- ------- - ------ -------------------•-------------- DATE_.--------{ ----�---------- -- -------------- ---------- -- BU I LD1NG PERMIT ISSUED-----------------------•---- - -------------- _` - f rL►---------- Alterations and/or recommendations:__-- -:--------�----------- --I-ns-- � - -- ---------•------------•------------------ I� ---------- ------------------------ - -- --------------------- r-------- ----------d-' ------------- -------------------- ---------------- -------------------- ------------------------------------- - t ------------------- ------------------- ------------- -------- -------------------------------- Date--- -----Date--- - - ----------------- --------- --- ------------------ --- FINAL INSPECTION BY:..-- .t- ------ ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5lockfon,California Lodi,California Manteca,California Tracy,California CS 9 REVIUEC 9-59 3M 3-163 r.P.CO.