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FOR OFFICE USE: ______________ l � ! ------- ------------------- 1 h APPLICATION FOR SANITATION PERMIT Permit No. ___ �_______________ S��L ----------------- ------ (Complete in Duplicate) Date Issued ------------------------------- This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Heallh District for a permit tp cgnVc yanEmsta work herein des l: This application is made in compliance with County Ordinance No. 549 �' or JOB ADDRESS AND �ATION--- -,k�----- =/�� ate` --------------- ---------------------------- Phone Owner's Name--------- . 1' Address---------------_------------- ...... ------• -----------------•--..-..-------------------.-------------------- lt _� Contractor's Name------ D �- �OA-------•------ - phone-------•--------------••----------- E Installation will serve. Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ----I_ Number of bedrooms .{. _ Number of baths __ Lot size ....../.51) C/.� ;Z-------------------- x. Water Supply: Public system ❑ Community system ❑ Private epth to Water Table 4c--, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cl ❑ Adobe ardpan Application Made: If es,date.--------_..__..---1 No -New-Gonstructiom:--Yes No ❑ FHA/VA: Yes No ❑ Previouspp ( Y TYPE OF INSTALLATION AND SPECIFICATIONS: , ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ij ~ Septic Tam. Distance from nearest weli__ 0------Distant# from foundation ll ' No. of compartments----- Size--_.,. lr'-- ---Liquid depth-_--. . > ---_Ca acit . - --------- ----------------- Cbis osal F' d: Distance from nearest well.__ Distance from foundation___ __Q .__Distance to nearest iot`lina,__�`-. x_ N 1101 Disposal Width of trench.-_-- _ ------------ Numberer of Imes._______.... ..............Length of each line-14 � -- _ Type of filter material----- ?j,ISDepth of filter material____. _. __ _ Totallength._.�47<_-------------------------__ _ a t ' I -1----- J Seepages if: Distance to near st welf -�. .._______Distant from cundation-___ «____:___.Distance to nearest lot line___-- Imo/ Number of pits_ ' -.----_Lining material-_- - ___..Size: Diameter. _ _'____--_C}epth_ - Cesspool: Distance from nearest well_.__-____.-----Distance from foundation.-._-f_.------f---.Lining material------------- I _.-__.-._. -____________________ �] Diameter. ----------Depth-t-------------------------- ------€---- -------- Size: Liquid Capacity ---------gals. Privy: Distance from nearest well---------------------------------------- --------Distance from nearest building----- -------::------------------------ ❑ Distance to nearest lot line----------------- -----------4-------- -------------------------------- ---- `----=------------------------------- ------------------ to Remodeling and/or repairing (describe):------- _ = °`�' f i - ----------------------- .p b --------------------------------------------:_-_--.__-____-------_-_--_-_--_-.------.-.--_-_-_--_,--__-._.--------_-.-_-__.____--.- .. ---------------------------------------------------------.._-__--____-------_-------__-___--_____- _---___1-----------------------__ _---__-_4-----___--------_-_---------_____-__-------------------------------_----. I hereby certify that I have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, State laws, rules an r ulations of the San Joaquin Local Health District. (Signed)------------------- -- ( ------ ----------------- ---------------- = -(/------------(Owner and/or Contractor) s B 3 - I buildin s etc. can ~ t- --- '- - -cmc.- - - _ .-h..��--�- --- ---------- (Plot plan, showing size of , location of system in relation to wells, g , p on reverse side). t FOR DEPARTMENT USE ONLY I1 •y _ APPLICATION ACCEPTED BY--------------- --- ----- --------------- ------ -- --------------------- DATE--------- r ----/`- -- ----------------- e------- REVIEWEDBY------------------------------------------ ----------------------- DATE-------- -------- ------------------------------------------ I BUILDItNG PERMIT ISSUED------------------- -- � -.---.-_-----_- _Z .., - ----------- DATE-------- ---------- -------------- � - — - ----Alteratons and/or recommendations:_ -------------------------------------------------------------------------- -------•------..._ ----- ---------------------------------------------------------------- ----------------------------------- - ---------- ------------ ------- ------------------ -- ---------- ------------------------------------------------------- - --- ---• ------- ----------------- Fl ------------- ------------------------------------------ -- Q , FINAL INSPECTION BY:...----Q '��"'�' -------------------------- Date--------`� r �' rpm ------------ ---------------------� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Av*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street iManteca,California Tracy,California Stockton,California Lodi, California F.P.CO. - s