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FOR OFFICE USE: 7 _ ---------- _ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------ ----------- y (Complete in Duplicate) ----------------- -L.0------------------------- This Permit Expires 1 Year From Date Issued Date Issued -------------- Application is hereby Lade to the San Joaquin Local Health District for a permit to construct and install the work herein described. Vis application-is'rx',ade in compliance with County Ordinance No 549. rs<, JOB ADDRESS AND CATION_------ � � �� --------------- --------------------------------- Owner's Name.----- �------------ "?I—Ay -------- ---------------- -------- ---------------- Y ' Phone----------------------------------- Address f r t Contractor's Name-----, - ----------------------------------------------- `Plio e..--• ----- Installation will serve: Residence Apartment.House ❑ Commercial Trailer Court ❑ Motel' [2 Othef ❑ _ ° .`Number of of living units: ______ Number of bed omms�-------- umber oT� aths- tot size -- -- --_� ---- --- ------ ry r Water Supply: Public system ❑ Community system Private ❑ Depth to Water Tab e-.1'1_ ft. Character of soil to a depth of 3 feet: Sand ❑ Grave l ❑ Sandy Loam ❑ Clay Loam 0� Clay ❑ Adobe 2_1q4ardpan ❑ Previous Application Made: (If yes,date-.-----,.�-_.�_--1 No © New"#Construcfiion: Yes Vo E] FHA/VA: Yes Flo El TYPE OF INSTALLATION AND SPECIFICATIONS;' �- l (No septic tank or cesspool permitted if public sewer is available within 200`feet:) Septic iprrDistance from nearest we __." ---.-_Distance from foundation_/-0-------Material__ ._ 0____ ft t No. of compartmenfi _.____ _ - -`..... -yl.VoLiqui6 depth____._ _.-�---------Capacity____._ -_ t �- f Disposal F' id: Distance from nearest w II____.. ^__..._Distance from foundation ___.,_�_ istance to nearest lot line--- I' [ Number of lines--- 1___._fit__ ength of eac line--- `-.�__ _ .y___.Width of trench.c��._ __--i�J ! Type of filter material___�. �j;-� epth of filter materia l -Total length--- I____________-._. Seepage P' ' Distance to near st well __ Distancef un ation ---- D' tarter foSnearest lot line---- -ram ize: Diameter__-_ D`e th___- Number of pits-�---------_--Lining material_!-_�__i�� --�"---� p �-----�/- ---------- Cesspool: Distance from nearest well----------_------Distance from foundafion----->_-----`�_Cining material___.__...____-..____.--____.__.___.... Size: Diameter------------------------------ ......Depth__ ----------------------- = ti ` -!.Liquid Capacity---------------------------gals. U) Privy: Distance from nearest well----___---------------------------_--------------Distance from nearest building.--------._-______.____________.___..._. [] Distance to nearest lot line----------- ------------------------------ - ------------------------ --------------------------------- -------- ------------------ Remodeling and/or re_airin describe :--- = � _.—..- �. _l —__ _::_. '.•''rr P 9�{ '=f f y ---------------------------- -------------- --------------- ----------------------•-------------------------------------------------------------------------- ---------------- ----------- ------------------------------------- '-------------------------------------------------------------------------------------------------------------------------------------------------------- --------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County. ordinances, State 1 ; and rules and, ulations of the San Joaquin Local Health District. C� ;« (Signed)------ --- �= � - (Owner and/or Contractor By:------------- ---- Title . i - ---- --- ---- - a- - (Title) (Plot plan, showing size of lot ion of.system..in.relation to wells, buil..ir%gs, etc„ an be placed_on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----- � ----- ------ DATE---�___- r---..------ REVIEWEDBY------------------ -------------------------- ------------------------------------------ ------------------------------- •--- DATE------------------------------------------ ----------------- BUILDINGPERMIT ISSUED----------•---- ---- DATE------------------------------------------- ---------------- c- L------ cu X-,------------ Alterations and/or recommendations:__.__ __..___ r____._.. - . - </--- --- // t ---------- -------------- --------�t------------------------------------------------------------------- -------------------------------------------------------------------- r ---•---------•-_-- — ------ ----------'............------... -- -------------------------------I----------------------- - ------- --------- — — ' ----------='-- ------------- -------------------------------- -- -------------•-••------------------------------------- ------------------------ 6 ' l FINAL INSPECTION BY:_._ (�1 tz / � ✓ ..Z 1 --a----- -- -�_ _ --------- Date----- ---- - - .a_ r - ----------------- SAN ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. �y 300 West Oak Street 124 Sycamore Street 205 West 9th Street + Sfocklon,California # � * JVLodi,Californiaµ Manteca,California Tr { acy;California F.P.0 O.