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h � -fly APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 CountyOrdinance No. rJ9. Z�7 JOB ADDRESS AND OCATION----- 0�-(--------�-s---------�----------------- ��= `-- Owner's Name-------- - -- ---•------ ��G - Phone Address------------------------- 4 c� ----------------------------------------------------------------------------------------------------•--•------------ Contractor's Name---------------- - --- ----- --------._--.-"------------- --------- -------- -------------- --------------------- ---------------- Phone-------- -------------------------- ` Number of living units: __.._Number of bedroom's Commercial F1Number of baths ---1--- Court E] Motel El Other ElInstallation will serve: Residence Apartment Hous _ ______________________________ Lot size ___��__X___�__�fl-l s � 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 ER�, Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes(& No ❑ 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: Distance from nearest well__:_____Dista ,from f9undatidn----------------- No. _-_-__-_�_____ Ma�pt�riai_ : 5� _ _ .______.__ /�,/'� No. of compartments-----� Size-- - ------Liquid depth------4----------------Capacity...-- ---------I/ 1Jv Disposal Field: Distance from nearest well----��__'___.._Distance from foundation---_.1D---------Distance to nearest lot line--- _._________ 91 Number of lines--------3_ _ ___-_ Length of each line ._-_� _. It Width of trench___.�_________________________ f[ ""t Type of filter material- __- ___ Depth of filter materiaL__.1- -------------Total length----_�-d--i)-------------------.---- . Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line____-".-.--._____ O ❑ Number of pits----------------------Lining material:---------------------Size: Diameter--------------.--------Depth---------------------------- I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------_______.______-_--_____ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------___._. ❑ Distance to nearest lot line------------------------------ ------------------------------------" ----------------------------------------------------------------- -- - Remodeling and/or repairing (describe)=------------------------------------------------------------------------------------------------_••----------------------------------------------------- ------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- ----- -----------------------------------------"--------------------------"--------- -------•-•-----------------------•------------------------------------------------"-r------------------------------------------- I hereby certify that I have prepared this app ication and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and ul ion of the San Joaquin Local Health District. a �i (Signed Owner an or Contractor == =' - -- . -- ------. ( i ) By:-----------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------- -- ------------.- ---- --------- (Plot p wing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- DATE - REVIEWED ATE REVIEWED BY------------------------------------- - !4_�.------------------------ DATE - BUILDINGPERMIT ISSUED-------------------------- ---- -----------------------•-------------------------------------- DATE-------- -------------------------------------------- Alterationsand/or recommendations--------------------------I---------------------------------------------------------------------------------------------------••----------•------------------- -•-------------- -------------------•-------------- ----------• --......--------------------. =� u ------------ ------------------------------- -------- ------- --'""- -_,-+P---------------- ----- - - -- FINAL INSPECTI{� —Bil. �� •- Date..... ` SAN JOAQUIN-LOCAL HEALTH/DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" $free+ Sfock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M REvised 0-'59 F.P.Co.