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FOR OFFICE USE; -------------------- ---. // 7 --------------------------------------------------------- APPLICATION -OR SANITATION PERMIT Permit No. --------------------------4 - ----- ......----- (Complete in Duplicate). iD/fig This Permit Expires 1 Year From'b) to Issued = Date Issued ----- Application is hereby made to the San Joaquin Local Health District for a pet:mifto construct and install t e work herein descr d. This application is made in compliance with County Ordinance No. 549. `n Q A Rr��40 JOS ADDRESS A D LOCATION-- T � ��`J -- -- -- -------- -- Owner s Name----- el --- _ r1 �'e - --=-----------f -------------A r --••----- - --------------•- ------------------------ --------------- ---- ------------------ -------------- ----- -- ------- Contractor's Name--------- __ --------------------- Phone Installation-will serve: -Residence Apartment House p Commercial Trailer -Court ❑ otel Other ❑ Number'of living units: _ .... Number of bedrooms �_ Number of baths Lot size --.7 / - �_ /` Water Supply: Public system E] Community system ❑ Private Depth to Water Table __�_ ft. Character of soil to a depth of 3 feet: "Sand EGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ k Previous Application Made: (If yes,'date---------- .-----) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool'permit+ed if public sewer is available within 200'feet.) ice,Septic T` Distance from' nearest well_________________Distance from foundation--------------------Material------------------------------------ No. of comp6rtmen#s--------------------------Size--------------------------------Liquid,de th---•-- ---------Capacity----------------------- ,�jDisposal,F�eld: Distance from nearest well__ _Distance from foundation__}) _ Distance.to,nearest lot I' e---476-.._. Number of lines--- _____________ _Length of-each line_-_ 19--.Width of french___-2?�t----_-.----____ Type of filter material_ Depth of filter material--.4-_ --..__.-_-Total length______ __ �__-----_-___-_-_-- eepage Pit: Distance to nearest well----------------------Distance from foundation__________.;:;__.Distance to nearest lot line_.__.___-_-_____ ❑ - Number of pits----------------------Lining material----------------------.Size: Diameter----------•------------Depth--------------------------- ----- Cesspool: Distance from nearest well_______________-Distance from foundation___._.--------------Lining material_--_.---_-__-------.-_-_-.______---__ ❑ Size: Diameter-------------------------------------Depth------:--------------------------:--------- --------Liquid Capacity---------------------------9 Privy:- -,--, .".: istance from nearest we1L; ------------------------------------------Distance rom.nearest building_______.------------------------------- Distance ________..__.. __. _ ._._. ❑ Distance to nearest lot line--------------------------------------------- -------------------------------- -----•-------- Remodeling and/or repairing (describe)___________________ ____ - w- ------------------------------------•-•---•-------------------•-----------•----•---• - --------------•-------------------------------=---=-•-----•------------------------ ---- ------ ------------------------------------- ------------------••------ -----------------------------------------•------------------------------------••--•--------•---------------------------••----------------------------------- -------------------------.------------------------------------------------------------------------------------------------------------------ ---•-------------- -------------------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules and re ula#ions of the San Joaquin Local Health District. (Signed)-•---_-- - -- _'--- - ------------- ---------------(Owner and/or Contractor) By:------------------ ---------------------------- - Title \ (Plot plan, showing size of lot, location of system in .relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r y APPLICATIONACCEPTED BY_---------- ------------------ ---------------- --------------------- DATE---=-------------------------------------------------------- REVIEWED_BY-----------------------__------- ------ .---- - -------------------- . DATE------------ d, -- ---------------------- BUILDING PERMIT ISSUED ---------'--- DATE. 12 and/or recommendations:--------------- ---------------- ----------------------------------------4------------------------------------------------------- ----:_ Y i . ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ f -_-_--•__----•_---_--•-------••-----•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- _____________________________ry_._._.____._ __.__.__._.__:_ _ --- ------- - -_ _ __--__-.___-__.__--------------_______ --------------- -...___-_..-.----_..-.------_.._._.__._______..__..-----..-.-_._.-- •-___ -r- k• -� ISI FINAL INSPECTION BY...----- Date �� f SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockion,California Lodi,California Manteca,California Tracy,California ES S REVI6Eo M-54 3M 3-•63 F.P.CO. s �•� - r� w ll