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FOR OFFICE USE: -------------------- ------------- -------- APPLICATION FOR .,SANITATION PERMIT Permit No. ____.�............. ----.-----:----- (Complete in Duplicate) � -s _ .�.-- _- _--_� ----____-------- This Permit Expires 1 Year From Date Issued Date Issued ----___._..71.___-_- 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 LOCATIONp ---------- 0--------------------------------------------------------------------------------------- Owner's Name c : -----••------ ---------------------------------- Contractor's . -------•-------------- -•-••---- Address.. 1 � --------------- r --'` Contractor's Name------W-C------ -----c ---:5-9-A-VA."Q----------------------------------- Phone------------------ ---------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t � t Number of living units: - __-___ Number of bedrooms __ __ Number of baths ----(__ Lot size ------fI�_________ _____�_�___-------------------- Water Supply: Public?system Community system ❑ Private ❑Depth to Water Table457ft. s fCharacter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P9 Hardpan ❑ Previous Application Made: (It yes;da e_._.,,_.._ - _,--,) _No [%L--`New_Construction: Yes• , No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: s r (No septic tank-'or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest o. from foundation_.�_Q____-___..Material.-C.(�N1.�'�_�.-l-tc------------------ i 1 I No of compartments.-._--- ._._______---Size_A:__ ----*5-----Liquid depth-_Ary2..+__-_-____-.Capacity.-fo'57�_�_____ Disposal Field: Distance -romin.earest weEl----itiQ_K&_.Distance.from foundation----- _-Distance to nearest lot line___�_--__-__ Number of knes____.Z.'_ .__""---__""'---`---Length of e—Ch,Iine-___a�`� ___ _ -__ r i � ,--,. - _ � �,w�---�--Width of trench----�'--.................... Type of filter material_�...j-�c_1�__Depth of filter material-------- length_____J_S_�-------------------------- Seepage :°_______________________ 1� See a e Pit: Distance to nearest well_._ytb4tm Distance from foundation-__.__l_Q_______. istance to nearest lot line-------s_.___-._ 4 g t < 1 DQ l �J Number of pits-----"Z- --------Lining material_" r-.�CQ_G�CSize: Diameter. }-' -�p--------Depth----_1.�_____________Y-------- I Cesspool: Distance from nearest well-----------------Distance from foundatior--------------------.Lining material------------------------------------- Size: Diameter--------------- ----- ----------------De th-------------------------- -------------------- -Liquid Capacity gals. �• Privy. Distance from nearest well_________---------_------------------------------Distance from nearest building-______-_-_________._________--___.:__-_. ❑ Distance to nearest lot line------------------------------ ----------- ------------------------- '---------------------------------------------------- Remodeling and/or repairing {dcscribe)_------_-------------------------------------------------------------------------------: -� --------------------------------------'---------------- -------------- - ------------------------------------------------------ ------ I -------------------- -------------------------- -----------7-----------------------------------------------------------------------------------------------------------`-----+------------------------------------------------------= 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 d regulations f the San Joaquin Local Health District. Owner and/or Contractor (Signed)----- - - ( ) By:----------------------------------------------------------------,------------------------------------------------------------ -----(Title)------ -- ------- -- ------- -- --- (Plot plan, showing size of lot, location of system in relation to wells,buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----C.......... � .fir----------- ------- ------ --------------------------------- DATE o ......1p�---------------------------- REVIEWED BY --_ _ �- --� -- ------ __ __=.:'-DATE'' --- -------------------------------- BUILDINGPERMIT ISSUED------------------- r------- ---------------------------------------------------------- DATE--------------------------------- --------------------------- I. Alterations and/or recommendations: x-----� ---------. �.)�1-----t ---- -�y`� �►1 e 2.e.S9-d ---� `7 .......... ------------------------------------------------------------------------�__:_� . --------------------------------•---------------- ---------- ----------- ------- ----------------------------------- -------------------------------- E f F -f FINAL INSPECTION BY:.-. - - --------------- Date ----I-�- �-r- - ------ - --- SAN JOAQUIN LOCAL. HEALTH-"DISTRICT 1601 E.Noxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slocklon,California Lodi,California Manteca,California Tracy,California F.P.r G.