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FOR OFFICE USE: ----------------------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. ......... ---------=----------------- - --- (Complete-in Duplicate) Date Issued -- I This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a ermit to construct and inst II the work herein described. This application is made in compliance with County Ordinance No '549. �> �� JOB ADDRESS AND LOCATION----- Owner's Nameb./_ _-r_9 A;- -olveJt�----- ---------------------•---------- ------ --- --------------------- ------ Phon�--------------------------------- Address----,' + _ _._ �[ _ 1F,S" A -2-1 --------------------- ----------------- _;0. ,, Contractor's Name_ .. - __---____ Phone. _ _ Installation will serve: Residence - ---- - -- ---- -- - sldence artment House ❑ Commercial [J Trailer Court ❑, Motel'3 Other ❑ Number of living units: __/-'___ Number of bedrooms _Number of baths---1._- Lot ........ Water Supply: Public system ❑ Community system k-00porivate ❑ Depth to Water Table6t9ft Character of soil to a depth of.3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ _,!;lobe Rr-OoHardpan Previous Application Made: (If yes,date...-.... .......... ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No FA-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S Tank: Distance from nearest well_______________-Distance from foundation--------------- Material .-.-.-_-___.-.-_____.________.______.-____-_ F j No. of compartments ------------ ------------Size-----_----- --- -- -----------Liquid depth.-------- --- -..._.Capacity................... I pisposal Field: Distance from nee est well."J_Distance from foundation--- _-____---.Distance to nearest lot line_ Number ofllines._ ___ -- __ ---- - ._Length of each (in f---------._-Width of trenc _________________ Type of filter material 4 Depth of filter matterial_-._- fr..Total length____________________st,' - f � I P 4f SeeZa Pit: Distance to near. st,well_-__ _.-.-.-Distant from foundatiortDis ante to nearest lot line_____ Number of pits: _-ARB--------- Lining material_-_- _. [$ize: Diameter._. p Cesspool: iDistarce from nearest well ________________Distance from foundation_....-........... ..Lining material__._...._--____--------__________- ❑ Size:'Diameter- 4-------- - -Depth------------------------------------- -- --- ---- Liquid Capacity--- ---------- --------- -gals. Privy: Distance from nearest well-------------------------- ........ from nearest building_-__----__-----------__________--.-_-_-_. ❑ Distance to'nearest.lot line .----------------- --------- - ---- ---------------------- •----------------------------------------------------------- Remodeling and/or repairing (describe)----------------------------------- - ------------- -- -----•---•------ ----------------- - ----_.---------------------•---------------•--------- r- ----------------------------------------------=----- ----.--•-------------- ° - ----------------------=--------------------------------------=-- -------------------------------------- I hereby certify that I have prepared this application and that the work will be done in acc dance with San Jo uin Count ordinances, S+a+ lawiNnd rules fqireguations of the San Joaquin Local He District. j J (signed} 4'- 1 --------Y �1@ Contractor) j ,.. Title} .............................. ---- By:--------------------- ----------------- ------------------ ------ ---- . (Plot plan, showing size of lot, location of system in relaf to wells, buildings, a ., can be placed on reverse side).11 + FOR DEPARTMENT USE ONLY 1i APPLICATION ACCEPTED BY.!__________ ------- - w-- - - ---------- DATE------ --7l�� ---�J----- REVIEWEDBY--------------------------- !--------------- -------------------------------------------------------------------- ------ DATE 5 BUILDINGPERMIT ISSUED-------- ----------------------------------------------------------------------------- --- --------- DATE-------------------------- ----- - ---------------------- . Alterations and/or recommendations......... /�% ------------ - ------•---- ---- --- ------ --------- -------- -- •-- - --- ��- -�------ - - --- ' -�_ ------- -------•--------------- --- ------------- --------------------- - LFINAL INSPECTION BY: --------------- Date-_---- / . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street $lockton,California Lodi, California Manteca,California1 Tracy,California E.H,9 2M 1.57 Vanguard Press