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`� FF e,O�ICE USE: / ----- --"----------------------- -------------_ .- ----- APPLICATION FOR SANITATION PERMIT Permit No. --- -- `,, ---- (Complete in Duplicate) . -.....-- " Thisermit PEx ices 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 descr bed.-�' F This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- 00, - --------------------------------- Owner's ---------------------------Owner's Name ••---. ------------------------------------------ ------ ------------------------------ Phone - ----- Address----------------- ------- kw \------•------------------- o.. Contractors Name_ _-_----- b_ -` - -_-"- !tr ,Phone zfQ___ Installation will serve: Residence �rtment,House ❑ Commercial ❑ T ailer Court E❑ Motel ❑ Other ❑ . Number of living units: _�" Number of bedrooms _Number of baths -------- Lot size __ _r._ /"p_Q__'-------------; i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ----- ft. I i Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam El Clay Loam E] Clay ❑ Adobe Hardpan ❑� Previous Application Made: (If yes,date ------ No El New Construction: Yes E] No No FHA/VA: Yes ❑ No ❑ 1 i TYPE OF INSTALLATION AND SPECIFICATIONS:_ (No septic tank or=cesspool permitted if public sewer is available within 200 feet.) Se c 7 Distance from nearest well_________________Distance from foundation--------------------Material--_.-.-.-_____.-_-.--------________-.- No. of compartments--------�- -------- Size----y---------------------------Liquid depth--------------------------Capacity---------------------- 1 Dis ?-Distance from nearest welllie -_.Distance from foundation___40----.__.Distance to nearest lot line---- --------- \ ,j NurnJer of lines_-_-_✓i___" -. :__ Length of each line__�Q_'-----------Width of french _ !.__ __ _ G1 Type of filter materia , . Depth of filter material___�J��______""_Total length_________________ ��p� of Seepage Pit: Distance to neareswell._.____ "_ _Distanc from' foundation_____�s�___.Distance to,nearest lot line_-__-_ __-_ . Number of is-__�[ --Linin material- _ o_-.-__ ______Size: Diameter_---__. �___De th_ --- i P 9 --- p �1--------- Cesspool: Distance from nearest well____-it-__.-____Distance from foundation___----_____--------Lining material-------- -.-__-.___`_______"_ I ❑ Size: Diameter---------------------- -- Depth----------------------------------------------------Liquid Capacity--------------- --------- .gals. Privy: Distance from nearest well____"-:_-.-_-___.__--__.-____-__."_-----------Distance from nearest building____"__---------------------------------- tEl Distance to nearest lot line------c.----------------".------ ------------------------------- ------- ------ Remodeling and/or repairing describe :_-r - -_ -— -- --------- ----------------- ` ---- -- ---- - --------------------------------- ' - --- - --- ~ � -------- c - - - ------ -- --------f-------------- --------------------------------------------------------------------------------------------------------------------------------• -------------------------- ------------------------------------------------------------- I hereby certify that )alwes aye prepared this application and that the work ill be done in accordance with San Joaquin County t ordinances, State lacw�s, aand regulations of the San Joaquin Joaq�u:iniLocal Health District. (Signed)------- ------ SEPCICNK" EVf = i ---- -- ----- r Contract1>rL M By:-----2915 E.MinerAye.� IiO,-f- 1,"-------- ----------- - --- -- -------(Title)------------------------- - --- (Plot plan, showing size of lot, location of system in relation welli, buildings tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ - ----------------- ------ ------ DATE---------- / �n REVIEWEDBY------------------------------------- ----------------------------------- --------------------- ----------------------- DATE--------------- -------------------------------------------- BUILDING PERMIT ISSUED------------------------- ----------- DATE--------------------------------------------------- Alterations and/or recommendations:-___--.-. � _ .__ -- ------------------------------------------------------------------------ - ---- - ------------------------------------------------------------ ----- -------------------------------------------- FINAL BY:.INSPECTION �---------------------".-------------- Date------------��_____�--�-�-- - ----�------------�--------- t SAN JOAQUIN LOCAL HEALTH DISTRICT / i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5lockton,California Lodi,California Manteca,California _ Tracy,California F.P.CO. i _