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FOR OFFICE USE: -----------------la_3 _- APPLICATION FOR SANITATION PERMIT Permit No. ___1....L... � --------------------------------- -- --------------- (Complete in Duplicate) Date Issued 7h-3-��/ 3 -_ __-.- _________________ --.------------------------ --- 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 compliant h County Ordinance No. 549. ?,O.$' a ZSc—'02 S .�— _ _ G JOB ADDRESS AND 1 LOCATION --- --- " / // �5 � ��I/ --Gsc �.•� Owner's Name---v_/t�/ �' 1 �1 '' J ------ Address ---- Phone �7 ? �/' - S a� 3 Address----------•%_=�.�Yc --- �,�'--------76--��-��5------------------�'-- -__, -_ _.____-�-��•-_-�----._....--•------_---_.-------------------------------.. Contractor's Name---------F`-. / f �1 c=-------------- ------------------------------- Phone--��'��6©,7 Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel Other ❑ Number of living units: --Q- Number of bedrooms ---40- Number of baths ---�- _ Lot size _---_-__-- ------------- Water Supply: Public system ❑ Community system ❑ Private [&-`6epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam [tglay ❑ Adobe ❑ Hardpan C3— Previous Application Made: (If yes,date-------------------.) No 5a----14ew Construction: Yes [4--No ❑ FHA/VA: Yes ❑ No [} TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pyblic sewer is available within 200 feet.)/ �q - Sepfic»Tank:, -Mstance-from nearest-well=-------_Distan A;tLi uid de th---- -- ------- Ca acif No. of compartments----- --------------Size_ q P- P yrA&7®------- v� Disposal Field: Distance from nearest well-- _"'Distance from foundation Q-��-------Distance to nearest lot l�ine-- Number of lines-2------------- Length of each line--------- _--.Width of french-___ .-T/ _11_1________ Type of filter me -Depth of filler material__/ ��__-.--.-Total length--,1.5~ :- ---_---_- yep Seepage Pit: Distance to nearest well- -.--Distance frqrfi foundation/4<---�_--".�;q?istance to nearest lot �{! ET Number of pits----_-------_----Lining material____ ,K --Size: Diameter-_33-------------Depth_.__-.- -----------------_ y Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____------_--------------_.-_- ❑ Size: Diameter------------------------------ -------Depth----------------------------------------------------Liquid Capacity------------------ --- ---:-gals i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line----------------- -------------------------------------------------- ------- ---------- ----------------------- Remodeling and/or repairing (describe):_-�.- __ f --------------------/��e -- /—— 4--_------•---�'-----A 5--------_ G _ 92e5____ --------- ------ ----------- ---------------��© � -y-- `�X ---------'�-C ��t-- -- 1 •�' - %p'. C4-/----- ��-��_- ------_�� r ----- �. 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, rules andregulationsof the San Joaquin Local Health District. ' (Si ned !. ----------_�' �� (O r /or Contractor) g )----:---------------- ---- 13 ( )------- y• Title (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse si�e]. y FOR DEPARTMENT-USE O -Ly APPLICATION ACCEPTED BY------------ ---------------- - ----------------------- 4 --_ DATE--------- --------------- REVIEWEDBY-------------------------------- ------------ ----------------------------------- --- ----------- -------------- --------- DATE_--------------------------------------------------------- BUILDINGPERMIT ISSUED------------------ ------------------------------------------------------------------------- --------- DATE----------------------------------------------------------- Alterations and/or recommend tions- -------------- ---------- ------ ---- ---------------------------I--------- --- - ----- - -------------------------------------------------- '0 ----------- ------------------------- - � .----�-- ��. -. ---------------- ------------ ? , ----------"- -- ----- --------- ------------- - ------------- -------------- - $ ------------- --------------------------- -------------- ---------------------------- FINAL INSPECTION BY: Date------------------- (.- - .!___ �_ _ SAN JO UIN LOCAL HEALTH DISTRICT 1601 E.hlaxelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street 51ocklan,California Lodi,California Manteca,California Tracy,California F.P.CO.