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FOR OFrFIC USE: 3 4, 31 r Ir_e 1� U �_ (- LY _J� �� APPLICATION FOR SANITATION PERMIT Permit No. . ...:.... .... --------------------------- _.__ - [Complete in Duplicate) ---------- -- Date Issued u _-- _, - This Permit Expires 1 Year From 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. pp f r E / Q/-- _ ---------•-----------•------------------------------- JOB ADDRESS AND LOCATION------------1��— - -------/C /..--- ` 5.�= f ( ,�. - - -------- ----------- Phone__¢&___-3_/. .Jr Owners Name--------------------------- - --------- - Address.---- --------------------- 1-42 --------- Ji ' --------------------------------------------------------------------------- Contractor's Name----------------------- L� '--------•--------- --- Phonel"�' � Installation will serve: Residence pertment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __Z__ Number of bedrooms _.:7r Number of baths ---/-- Lot size -_.l`J'' ------------------------- <.Water Supply: Publicsystem ❑ . Community system ❑ Private.[ epth to Water Table l00 ft. Character of soil to a depth of 3 feet: Sand El -Gravel ❑ Sandy Loam El 'Clay Loam [Clay E] Adobe E] Hardpan C] Previous Application-Made: {If yes,date--------------------) No"[�}�New Construction: `Yes ❑ No [�fHA/VA: Yes ❑ No [� TYPE 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__r'__.-._____:..._.Material----_.._____-_____...__---___._____________.__. � ❑ No¢ of compartments------ ---------------- -Size_------------------------------ d depth__------- -- - - -------Capacity----------------------- 10 sp�os/al Field: Distance from nearest well.. '`�- __._Distance from foundation-_.�1� .----istance to nearest lot line--- ------ P a --Length of each line_."!© �' t` trench-_____. w_____________ r Number of lines---.--:-----/�'--:- -- ---- - -- - Type of filter mated = �G<Depth of filter material-__/k otal length-__--11,9P--_--_ _______________ :e - � r. - Seepage P Distance-�to"hearest well--- -Distance fro foundation__�1` _�____.pistance to nearest lot line_________________ w mber of.pits-------/---- ------Lining material-- -/ Size: Diameter--- -.`.----_ --Deptn....� -------------------- Nu' W Cesspool:• Distance from nearest*well--------------._-Distance from foundation_____________ ______Lining material_ _______--,___.._____.._._. N 0 Size: Diameter--------'----- ---------- ------------Depth-------------- ------------------------------- °_.. Liquid Capacity----------------------------gals. # .. Priv Distance from nearest well-------------------_-------- _-_------__----Distance from nearest building_.-______.________._______._.____.-__-.. Y� � � k ❑ Distance to nearest-lot line---------- ------------------ - - -------------•------------------- ------------------------ --- ------------------------------ k Remodeling and/or repairing (describe)________ ___________ --- ----------- ----------•----------------------- - :`_t------------------•------------------•--------------- . -----------=-------------- - --------------------------- ---------------------------------------- ---- --? .[ -------------------------- - -------------- -= =------ - -.---------- --------------"-"------------------------------•------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the'work"will be done in accordance with San Joaquin County 'Qp ordinances, State.laws," es and regulations of the San Joaquin Local Health District. - = - ne nd or Contractor)--L (Signed)---------------- �. 1J -U--------------- a By- ---,--- ITifie)---- (Plot plan,`showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY e-�- — DATE-------- .lz-:4 ~------------ APPLICATION ACCEPTED BY..-._-- -- -- -- ------- = � REVIEWED BY ----------------- DATE-------------- ----------=------------=---= ------------ - ---- ---- ---------------------------------------=------ BUILDING PERMIT" ISSUED--------------------- --------------------------------------- ------------------------ ---------- -. DATE---':-----------------------------------=---------------- -- - -- Alterations and/or recommendations:--------'-'-"--^"" _:: �•-------4--------•---------7- --- ---- - ---------- ------------ - - ------------------------ _ -a -------- ---------- -----•------------------------------------------------------ -------------- --------------- --------------- ------------------•-------------- •-----. -------------------------------------------------------------- ----------------- . r ___1FINAL INSPECTION BY:.------.............. l/--------- ------------- Date--- . (� --------- --------- -------------------------- N JOAQUIN-LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t Slockton,California Lodi,California Manteca,California Tracy,California 3