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FOR OFFICE USE: 6 `--z "-7 ---- APPLICATION FOR SANITATION PERMIT Permit No. -- - ---• ---=-- l- i (Complete in Duplicate) - -- --- --- ----- 'M This Permit Expires 1 Year From Date Issued ��'! Date Issued Application is hereby made�tethe San Joaquin Loca! Health District for a permit to construct and install the work herein described. This application is made in compliance with County dinance No. 549. COS—ZY 0 -D+� ' JOB ADDRESS AND 33s-7A) .� . ;F ---------- _ ^_- � --------- --------------- Phone Address-.Name------------•----- *5_10r Z;✓o z -P 7 ..._._ _. 60 Contractor's Name_______ N � S SS��-- , l ----- �' ---------------------- Phone..-4A.I �� Installation will serve: Residence Apartment House ❑? Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ lints Number of living units: ___�_ Number of bedrooms __�;Number of baths .� /��,�./��`�_------------------- Water __ ____ _ _ Lot size ___ Water Supply: Public system pp y: y ❑ Commuffity�ys+em ❑ Private 2' Depth to Water Table ��4? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑":.Sandy Loam ❑ Clay Loam /Clay ❑ Adobe ❑ Hardpan ❑ -,., r e : �, ti Eq� Previous Application Made: {If yes,date_..__-._._,-_..___.J` N New Cons+uction:'Yes (] No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permiftedfi.pubiic sewer is available within 200 feet.} a.. Septic Tank: Distance!from nearest e!f-• __.__#.___,Distane from foundation___________________.Material-____-.__________--__._-_________ _- ------------ ❑ No, of compartments-------------- ---- ----Size__ ---------------------: Liquid depth--------------------------Capacity1 Dis osal Field: Distance from nearest well.. -- Distance from foundation---- ----- ------Distance to nearest lot line_____ _____--. Number of lines-------------- -- Lengtl of each line----, . ------------Width of trench.-__q '`'--,-------------' Type of filter materia#__ro.,;4/-lf__-__Depth of filter material--__, Y'Y- ._ Total length---------- ----- -------- 1 Seepag Pit: Distance,to nearest well_-ra'_[--...-- Distance fro foundation__ istance to nearest lot line_-*�___f- pp Linin material__ _ �1 Number ;fits I' � ! Depth- °= ------ p - ---------- g _ _ �= Size: Diameter_- _ % Cesspool: Distancej�from nearest well_________________Distance from*found tion.-.___________-_--.Lining material _.____-_____-____.____.________._ ❑ Size: Diameter----- - - -------- ---------- -----Depth-------- -------------------- - ----------------- Liquid Capacity---------- -------------gals. Privy: Distance from nearest'well_____________________________...______-..___._Distance from nearest buildin }' ❑ Distancelto nearest lot line---_---. g____-_-.____ --------------------------------------------------------------- NNN ---------------------- ------------- Remodeling and/or repairing (describe):__.._____ - W. . .. ......... ------------ --------------•--------------•---------------- I------------:-------•------------------------------------------------------------------------------------------- I---- --------- ------------- 1. ---- 11 71 ---------- . . . --------- ---------------------- ---------- ---- ----- --- ----------------------------------------------•------------------------------------------------------- ---------------- I hereby certify that I have prepared this application and that a A will be done in accordance with San Joaquin County ordinances, Stat d les and regulations of the Sa aaq in La I Health District. (Signed)----------------------- .---- O ran or Contractor By: ----------(Tit (Plot plan, showing size o to ; locatian of syst m in eEation +a wells, buildings, etc., can be placed on reverse side). j� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BIY -------- --- --- 1� 'L ---------------------- DATE � __.�......55?1 REVIEWED By ------------- F ----- --- ------------------------ -------- ---------------------------------------- -- DATE---- -- ----------------•- ------------- -- BUILDING PERMIT ISSUED---!(----------- ------ - - _ � ^--------------------1, DATE--------------------- - - ------------------------------------------------ Alterations and/or recommendations: -_ - �s��-�� _fi —F---_ �' `-` --- ----------- `-------- -------------------------- -S f------�--a i�----------- ---- ........ - ------ •-------------- ----------------------------int-------------------- ------ �'`""`�= ---------------------- --------------------------------- --------------------- ------------- - ----j-------------------------- - - - ------------------------ ---- ----------------------.. Y ) FINAL INSPECTION BY:- !-------� `�-- - ---- Date---- ff- ,� �` SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy, California F.P.EO. r