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FOR OFFICE USE: �---------------- J----- 4. r_..___.__-_ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- - -- - (Complete in Duplicate) ' } This Permit Expires 1 Year From Date Issued Date Issued __~ ------- ------- — -�/ ---------- Application ------ -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. JOB ADDRESS AND LOCATI N--------------- ---------- --------- - 4- -------------------------------------------------- Owner's Name----------------�-------�- - �-t-0-9--------------Jce---a ------------- ---------------------------- -- 1 - _�Address-------------------------------- ------- - ------------ Contractor's Name. !---------------� Z----- -- ^ Phone_ jt6_ _ .V� - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ! 1 y i Number of living units: _1_._ Number of bedrooms __4'_ Number of baths -------- Lot size ------------------ Water Supply. Public system �4 Community system ❑ Private ❑ Depth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam A ay ❑ Adobe❑ Hardpan ❑ Previous Application Made: If es,date------ -----------) No New Construction: Yes ❑ No X- FHA/VA: Yes ❑ No �, pp I Y ,®- No, X- 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-------------------Material-----------------------.------------------._____- ❑ No. of compartments-.-. -------- - ----- ----Size--------------------------------Liquid depth-------------------------Capacity----------------------- Disposal Field: Distance from nearest well ___.-- ------.--Distance from foundation_j$,0...-----Distance to nearest lot line___�,Q-f__. _ Number of lines---..-.-.t---- --- -------------Length of each line------ --____--Width of trench--- .- -��-__-_________ — Type of fi{ter material._-, ��,ey<__Depth of filter material.-.� -_________.Total length__/ __ ________-------- un _____________ Seepage Pit: Distance to nearest well---- __-.----Distance fr fo Rndation__r ,1_-___ Distance to nearest lot line__ -------- Number of pits.-..___ .-_._ `Lining rrieterial_ �j _Si ze: Diameter,_-, _'�.-.___Depth_...__, ` ----------- Distance from nearest well------ ------- -_Distance from foundation____-___-__-__----Lining material--------------------------------- IJ Size: Diameter.----.------------------- ---..De th .---------------il------------ '---Liquid Capacity.- -----gals. Privy: Distance from nearest well__ __._.-__ _ ___ k__-L ,_-t_-�_Di�tance from nearest but{din .�-.— �,- g ---------------------------------------- ❑ Distance to nearest lo -- -------.------------------- -----------`----.----- --------------- -•. A ----_-- ------------------•----------------------------------------------------------- :----------- ----- - ------ ------------------------------- ----- ---------Remodeling and/or repairing (describe): - -----------------------------------------------------------------------------------''ll------------------------------------------------------------------------------- _____________ _ ____ _ __ _____________________________________?__-___-__-________-_-____:--__----________-•--.-__________.______.__---------_--_-_'_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 ru and re t s of the San Joaquin Local salt tricf. f� (Signed) / --------- W. .-/ '_ . wn rand/or ' Contractor) B �=P „� f't1 Title) w.�= � -- - ----- - Y•------ --- -- ---- ---- - .. (Plot plan. showing size of lot, locat' n of system in relation to wells, buildings, etc., can be placed on reverse side). t I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----- '" 3 5---------------------------- DATE------ -------------------------- REVIEWED BY --------------- -----�--------- ------------------------- DATE-------------- ------------------------------------------ BUILDING PERMIT ISSUED----------- DATE------------------------------------------------------------- Alterations and/or recommendations ) = '. -------------------- ---------- ------------------------------------------------------- ---------------------------------------------- ---------------- ---------- --------------------------------- --------------\" ---------------I-------------------- •---------------------------------- ---------------------------------•---•--------- ------------------------------------ ----------------------------------------------------------------------- -- ----- ---- ------- -------------------------------------------- -- ------------------------------- ------------------------------------- FINAL INSPECTION BY:). Z--- No--- ------------------------ Date_._.-��--6-------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton:Av300 West Oak Street 124 Sycamore Street 205 West 9th Street " ' l Lodi,California Manteca,California 'frac California Stacklon,California'' Y. . "F.P;CO.