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FOR OFFICE USE: ---------- ----------------- -------- ---------- - APPLICATION FOR SANITATION PERMIT Permit No. �f �,. ------------------ ---- ----- ---------------- --------- (Complete-in Duplicate) �� " ___ ._ _ -----_---_----- _..__.__...._ Date Issued -.-_-__.___--___ -.- This Permit Expires 1 Year From Date Issued - - • I l 3 --- l`fie-c3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein descrbecgi, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_. aT'G .Ue'4 :/ L"= 1 , g ' � %"cC'> k'�� Owner's Name � � U i�`�' ---------------- P6one-=---- ---------------------------- Address ------------------•-------- / c/--- .-C-------------------------------------------------------- Address..-----------•---52eAl�? � 014I.V ------------------------------- •-------------------._...----- r Ia 3^ Contractor's Name---- -f---- �l- Phone. InstallMion-will serve: Residence ❑ Apartment House ❑ CommercialTrailer Court ❑ Motel [3Other ❑ Number of living units: -- ----- Number of bedrooms -------- Number of ba hs ........ Lot size _____ 'Ne _ _ 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 ❑ Hardpan L Previous Application Made: (If yes,date-----.-.----------- ) 'No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No Ej.h•` I 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---, ---Distance from foundation l_- ._-.-...Mate al ...__ _-------------------------------- No. y ___ _.__.No. of compartments...__...= ........ _.~ .--- ._,�_k Li uid de th.-.--_':V":4—:- .....__.Ca acit ,__FF ---_--.--- Disposal Field: Distance from nearest well._-. _-Distance from foundation. /.f..--...Distance to nearest I t line_-_- Number of lines____-_____4_.__.. .-.-___-l-Length of each line__ ----I- - ---------.Width of trench_________________ _ C �A_ Type of filter material__I_Qtfe._�__Depth of filter rriaterial_._._1_F..�.........Total length---------------1_,9_-_______---_.-. Seepage; Pit: Distance to neorest-well-_ -k- ------------ Distance from foundation-------------------Distance to nearest lot line------_---.---_. ❑ Number of pits-- ------------------Lining material.-.-----.._.--------.- Size: Diameter.-------..---._---.__--Depth--------------------------__t Cesspool: Distance,from nearest well ____..._____.__Distance from foundation................. ..Lining material_._......--__-.. ._.___..______❑ Size: Diameter- -- --------- ---�-------- -Depth- ------------- -------------Liquid Capacity-------------- -------------gPrivy: Distarcelfrom- nearest well_______________________._..____._....-.___.-.._Distance from nearest building___---- ___----------_-❑ Distance to nearest lot line -..._--- -- -- ------------------------------- -------------------- ----------------------------- . Remodeling and/or repairing.,(describe):--------------------------------------------•--------------------------------------•-------------------------------------------------------------------- ,. -----•---------------•------------------------------------I---------------------------------------------------------------------------------------•-------------- ------------------ ----------- ----------------------- --------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. � t t racto(Signed)-------- ----- - -------- ----- --- -- - a - (Owner and/or Cont Ely:-------------------- ---------------------f-------------- -------------- ------ ----------------------------------- ---(Title)---------- ------ --- - - ------------- -- ............. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �r.s R DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE---?---- ._ �----------------------- REVIEWEDBY---------------------- ------ ----- --- - - ----------------------------------•---------------------------- DATE---•-- -------- --- ----------------------------` BUILDINGPERMIT ISSUED--------- -------- - ------------------------------------------------------------------------------- DATE----------------------------------- ------------------------- Alterations - ------------------------------ Alterations and/or recommendations--- ------- ------.-------- ----...------.... ------------------------------------------------ -•--•---------------•--------------------------•------------ ---------------- •-------------•-- - - ------------------------------------- ---- --------------------- -----•----------------------------------- -------- -- ---------------- -------------- ------------------ ----------------------------------- ------ ------------------------------------------------ -------- --------------------•------------•-----------------•- ------------------------------------------------------------ -------------------- --------------------------------•--- ---- ------ ---------------- ----------- -------------- ------•----- ------- ------------- ---------------- .....-- - -------- --------- . --------- .. ........-........... .. .. . ---. FINAL. INSPECTION BY: -... ------------------------------- Date-.-...- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5lockton,California Lodi California Manteca,California Tracy,California E.H.9 2M.1.67 Vanguard Press a �.