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FOR OFFICE USE: _________________________________________________________ k ------..--_--------------------_---.----..-.--_----_- APPLICATION-F 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 insfall the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------.------ -�_��_r� Owner's Namej ----------- Z_Q------------- ------------- - -- - -------------------------------- ------ Phone-__l___�'�� 61C� Address -- ----- �--�-----�-----P-�------rl--�---t-�----C--------x-C---�----�-'-�----�----- ------------------------------- -------------------------------- 17 Contractor's Name----- --------•---•-----•-•----------------------- --------------- ------------------------------------ ---- -- - Phone------ •-----------------•--------- Installation will serve: Residence M---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /____ Number of bedrooms _. _ Number of baths Lot size ------- __. -____.__- ti 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 ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (1f yes,date-----------.--------) No --New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ Q I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: I rDistance from nearest well_________________Distance from foundation--------------------Material_____________..__________..___________----___---. F _7� ❑ y-� o. of compartments------------------------Size------•--------•----------------Liquid depth--------------------------Capacity----------------------- , Disposal M Distance from nearest well__�- .Distance from foundation___./_a�_____Distance to nearest lot 1' 'Ile 01 Number of lines------------------- ------_----.-Length of each line---------- .Width of french--------9-�------ ----�------_-- � �� Type of filter maferial___ ��I�Cf.__Deptl7 of filter material_____� '_`__`__Total length_______-.__ _------- Type - ----------------------- Seepage Pit: Distance to nearest well__-�K/_____Distance from foundation__1_D/____ Distance to nearest lot lin __-__ ---_ Number of pigF _""Lining materia meter- ______ _ -___ eptn__ ____ _______________. 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------------------------------------------ E] Distance to nearest lot line-_-_.---- ------ - Remodeling and/or repairing (describe)--------- - ------------------- ------------------------------------------------------------------------- -----------------------------•--- ------------------•-------------------------------------------•--------------------------------------------------------------------------------------------------------------------•------------------------------------------ --------------------------------------------------------------------------- ----- ---------------------------------------------------------------------------------- ------- ----- I ----------------------------------------------------------------------------------------------------- ----------------------------------•------------------------------------------------•------•---------- ------ I hereby certify th I have prepared this,applicafion and that the work will be done in accordance with San Joaquin County ordinances;. SfAklaws and rules and regufla#i s of the San Joaquin Local Health District. (Signed ___-- `- -------- '` ------------------------------------------- -(Owner and/or Contractor) BY=------------------------------------------------------------------------------------------------------------- -=.--------------------(Title)---------------------------- ----------------------------------- (Plot ---------- ---- - ------------ (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 ACCEPTED BY.--------- --� -- ------------------------------------ DATE------ -----9----111-eF� f REVIEWEDBY---------------------------------------------------------- ---------------------------------------------- DATE_- .-------------------------------------------------------- BUILDINGPERMIT ISSUED------------------ ----------------- ---------------------- --•---------------------------------------- DATE------------------------------------------------------------- z� Alterations and/or recommendations;---------��- - --�---1-�-�--'-- ----------------- 7�- --------------------------------- ------------- - -------•-------• ---�=---"��_�r"?—��:__�✓. .. Er- it --------------------------- �+—9 ` y-C-per---- ' 1r - 2' � r -- ......... r— Z = ' ------ ;,I •-�1c_1�----------------- -------- -------------------- ��''t'-� �i-+(•�',...5� '�"� t��' .�.�'�__ ��e� FINAL INSPECTI BY: ._ -- _- ----------- ' �� ' �..•_�� . �-- '�N J�� U I N • CAL HEALTH G-o�- -�•p�-!'- zJ, DISTR `1601 E.Ha:ellon Ave, 1,Y-T-35OZ st Oeel 124 Sycamore Street 205 West 9th Street _.�'- cie r�<-raccyy Stocklon,California Lodi,California / Manteca,California - Tracy,California i F.P.0 O.