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FOR OFFICE USE- -------- SES `- ----ia� 1-0----- ----.-c ._ ------ ---------- ---------------------- t--- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ...1-� •--�I--------------- - (Complete in Duplicate)vFA lica#io fThis Permit Expires 1 Year From Date Issued- - - 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 County Ordinance No. 549. 1. JOB ADDRESS AND LOCA••-T--I-O- N_ 3- 44+p3 . Owner's Name-- � s& L �Pw_y� ri - _----'-- -------- ------------ ------------------------------ ---------------------- ----•- -----------------------•--•--------- ---------------------- •------- ---------��•---------------------:-- ------------------------ PhoneAddres _.__...-- + -- -_ ry1111-4_. -------------•-------•------ ------------•----------------•-------- ------ Contractor's Name--------.-- ` % ' -- :� , o I Installation will serve: Residence Par+men# House E] Commercial Commercial ❑ Trailer-Court ❑ Motel ❑ Other ❑ + Number of living units: ___1___ Number of bedrooms _3--_ Number of baths-_--I--_ Lot size _aS"u x ------•---------- ---------------•-------- I Water Supply: Public system ©"Community system ❑ Private Cl' Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] 5611cly Loam ❑ . Clay Loam ❑ Clay ❑ Adobe( Flardpan ❑ Previous Application Made: (If yes,date--------- ---------.) No R�r New Construction: Yes jFj'__No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 fee+.) - `\ Septic Tank: Distance from nearest well_--~-------Distance from foundation__/G*- :.Material__l-": - p1JV No. of compartments---.�,-------------------Size---_y�� , � --- - -----=-------Liquid depth----�------- --------Capacity--- • Disposal Field: Distance from nearest well__ ------___------Distance from foundation•___..,_____:____.Distance to nearest lot line__---___._____.._ L� Number of fines_________ac___________________Length of each line____ ---- g 7 Width of trench__9--- Type of..filter material..749A' -----------Depth of filter..material_Y8_--_--_______--Total length_._JSp ��±�±-� ---- Seepa Pit: Distance to nearest well __" -------Distanc"rom foundation/47' -.Distance to nearest lot line_.# Number of pits---4 -------------Lining material__. O .--------Size: Diameter---;�_rq-r-,--------.Depth------�! 1-----•- 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);---------------- --_------ _ , ---------•-------•--••--------------------------------•------------------ --------------------------• ---- -------------------- - 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. (Signed)------------------------- - ------------------------ ------- By:_ - r - (Owner ner an r Contractor) or) -... -- - -------------------------------------- ----------(Title)--------------------------------"-- -- (Plot plan, showing size of lot, loca+ion o 'system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED s ___________ ------------ ---------------------------------------- DATE----%----- -.REVIEWEDBY------•--------------- --------- - - ----------------------------------------- -------•. DATE__.. -------- - BUILDING PERMIT ISSUED--------------------- s - DA•TE-------------=-------------------- A( rations and/or recommendations: �' l ��--------- 1 ------,I.K_s A----_-•---- -%1_eA _ ' .----- --------------- ...------------------------------- ------------------------- -------------------- k ------------------------------------------- FINAL INSPECTION BY:.-------- --------------•----- w Date_--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED Q-89 3M 3-•63 F.P.Cq,