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FOR OFFICE USE: _ - „-___ - APPLICATION FOR SANITATION PERMIT Permit No. ...1.. .� -.... r a.0 -Ca-- ------ '�` (Complete in Duplicate)-� C- 3 ---Date issued ----------------------- 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 Ordinanc o. 549. C'o JOB ADDRESS AN OCATEON_ .z ---------------------------- Owner's Name- Ve f Phone ------ ho+e Acl&6�1 ----C-0,Y3.7. Contractor's Nar Rj ----- 1 �•--- �'i°J e Phone__ X` 6 Installation will serve: Residence partment House ❑ Commercial ❑ iter Court ❑ Motel ❑ Other ❑ Number of living units: I______ Num +3r of bedrooms _ZlVumber of baths ___J__ Lot size --- _______ Water Supply: Public system Community system ❑ Private ❑ Depth to'Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ' Sandy Loam ❑ Clay Loam.❑ Clay E] Adobe Hardpan E]Previous Application Made: (If yes,date------ -------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic r cesspool permitted if-public sewer is available within 200 feet.} t" an ;: Distance from nearest well_________________Distance from foundation- ----------Material_____---:___-:--______--_--__-________-_______. No. of compartments--------------------------Size--------------------------=----•Liquid depth-------------------------:Capacity----------------------- s . l- iel Distance from near st weII�l�Distance from foundation___f.__ .__Distance to nearest t`li �� _ Number of lines_____ __ ___ ___ __ __ __Length of each line_-�_0-- ----��.Width of trench_5�'!54_" p--- ____ Type of,filter maferiepth of filter materia�_________f��______Total .length____________________ __.______r t _ = yam' t Distance to neare t well ____�'l:�___Distanc om f undation_ __ ___.:Distance to nearest lot lin 1; ._ Number of pits_______________ _____Lining material.. Size: Diameter_ J!"_Depth------ _-_�______________ Cesspool: Distance from nearest well_________________Distance from fo ndation-----...............Lining material---------_________________-__-__.____ Size: Diameter--------------------------------------De th-------------- ------------------------------------Liquid Capacity gals. O ' Privy: Distance from nearest well-------------------------------------Z'______-Distance from nearest building--------------------------,___--____-._._. 00 ❑ Distance to nearest lot line- --- -------------------------- ------------ ----------------------------------------------------------------------------------------- i Remodeling and/or repairing {descri.a,eI : L4 __________________________ k ------------------------------------- --- _______________________-------- -------------------------------------------------- ____ ' CP I hereby certify that I have prepared this application and that fhe work w be done in accordance with San Joaquin County , ordinances, jitate la&w , and rules and regulations of the San aquin Local Health District. Si ned 1JU� _ �_._ 9 )---------------------------�`-�---�-- -------- ------- ------- - is, ��--- --- -- -� -:-- ---------- ------- ntractorl 3 -- By:. r tritle)---------------------------------------- ------- ------ (Plot plan, showing,size.of lot, location of system in relation towildings, e� , can be placed on reverse sidel. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---- ------ ------------------------------------ DATE - --3rd REVIEWEDBY-------------------------------------------- ------------------------ ------'---------------------------------- DATE----------- BUILDING PERMIT ISSUED---------------------------------------------------------------•----------------- ---------------- -• DATE------------------------------------ ------------------- Alterations and/or recommendations:___° _________:.-_____-_-_ --------- ------------- ----- ---------------------------------------------•------------------------------ --G- _.-_- - --- ----- !' ------------Crr ---------------------•------------------------------------------ - I------------------------------------------ ---------------------- ------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------- ---• : -----------------------•-------------------- --------------•---------------- ------------------ -------------------- ------------------------------------------------------------------------------------------------ V FINAL INSPECTION BY:. -- -�---=°�------------------ ............ Date = :_�_x.........--- - -- - ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 91h Street Slocklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.Ca.