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FOR OFFICE USEc ---------------- - -------fir.._?. _.�_.-7..�..(n_ ----`-._`f. '`7_,- APPLICATION FOR SANITATION PERMIT Permit No. 1V--------------------- ------ : -------------------------- ---- ----------- ------ (Complete in Duplicate) This Permit Expires ] Year From Date Issued Date Issued _ '_ ---------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the ork herein desc{bed. This application`,iS made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIONf�P_YS�•_tj _ ��f __f/7.._ Q.• lfd�-----? -- ,fQ,l- ,�¢,�---------------------- Owner's Name__ Phone- _/� _- ---- _ SG, 1 � •--------------------------------------------------------- -------------------------- 6 Address----=._1-6 -- - � v`�/�� - - Contractor's Name-----------I-ea/ --=-,� 14r� l------ ----------------------------- -------------------------------------------•--- Phonn-----------r.---------------------- Installation will serve: Residence pa�'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E Number of living units: Number of bedrooms . -- Number of baths. -___ Lot size _ P1 ' _'_____________________________._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 4�_ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe 99-"Hardpan ❑ Previous Application Made: (If yes,Fdate-----------------___-) No [7]-' New Construction: Yes E- No ❑ FHA/VA: Yes 8--- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r �s Material �® 'r `�'r Septic Tank: Distance from nearest well___ _D-------Distance from foundation...l�______----- [ No. of compartments...A-----------------Size r_-"-1A--3--•Liquid depth.__-�..................Cafacity_� ------- A Disposal Field: Distance from nearest well .!Pe Distance from founddtion_A©---_______.Distance to nearest lot line_ -------- - [� Number of lines______•___-�---:.�____Length of each line___ ' ___._._.Width of trench.A.__---------- ___________�_ Type of filter material , !��_ Depth of filter material---_._------------Total length___ I�r_____ -AN Seepage Pit: Distance to nearest well--//O......Distanee from foundation---3�--_:__.Distance to nearest lot 14- Number of its.._. " ` ' # _ Linin ---- - -- _ p ' �`�--��-�-�-��--- m . p 1'.�---___--- _-- g 'material-- --- -.Size: Diameter_s�e3_ _,,_---- -De to Cesspool: Distance from nearest well_________________Distance from foundation------------------- material_____--__.________.______.________- ❑ Size! Diameter...{------------- ---- -------Depth----------------------------- ---_ - -Li quid' Capacity ---gals. j Privy: Distance from nearest well--------___----------------_------------___._. Distance from nearest building---------------------------------......... ❑ '" u ,'Distance to nearest lot line-- -------------------------- ---------j------------------------------------------------------------------------------------------------------------ Remodelin ador, re' irin� escribe ------------------•-------------------------_------------------------- -------------------------------------------------------------------------- ------------------------------------- --------------- + J 1 - : f ! 4 a- -------------------------- I here6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 14. (Signed) --------------------------JOyor Contractor) I ISF.f • _____________ f - -----------=-------- -- =-- (Plot plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse.side). FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY t' ----- ------ --------------------------- ------------ =------ DATE 7 ` X' -------- REVIEWEDBY---------------------------------------------'-------------------- ------------------------------------------------- ------- DATE----------_1/-------------- BUILDING PERMIT ISSUED---------------------------------- ------ t DATE---------------------------- Alterations and/or recommendations:____ _ -_ _ -- ---------------- 3 a � `�`- ` �� Z - --- - C r . e - z Gam;y --------------------- -----�--- i' -`-'`- •----------- ----------------------- --------------------------- ------------ ------ ----------------------- ------------------------------------------ ----------------------------- ----------------------- ------------- ------------------------------------- -- ---- ------------------------ -- - ------------------------------------------------------- -•-- --------------------------- ------- ------------------------------------ { FINAL INSPECTION BY: . ' - Date---------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street fl 124 Sycamore Street 205 West 9th'Street Stocklon,California Lodi,California Manteca,California Tracy,California t