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- -1 ------- ---------- ��,�_w_ APPLICATION FOR SANITATION PERMIT Permit No. __/...!- ___-!_.S._. ------ -- --- --------------------------------------- -- (Complete in Duplicate) 6/��6 3- -- - -- ------------------------------------------........... This Permit Expires 1 Year From Date Issued Date Issued ____l--__ _____.r 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. JOB ADDRESS AND LOCATION------ 3 4------L'1 ------- ........ --r� ------------------------------•-•-------------------------------- Owner's Name--------I - --------a_ ----------------------------------------------------- Phone--------------------------------•--- Address--.........._/_ ' ------- Contractor's Name 9V _K " Phone .. = Installation will serve: Residence ❑ Apartment House Ir Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _2____ Number of bedrooms _ .___ Number of baths ___Z__ Lot size ----------9-_4------ .--_____________________ Water Supply: Public system [l-Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E' Hardpan ❑ Previous Application Made: (If yes,date------- ) No &' New Construction: Yes ❑ No [31-- FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ..: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tnk: Distance from nearest welf_________________Distance from foundation__.__________-_.___Material---.--------------------------------------------- ,e4 No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well---IVo-------Distance from foundation----/.n-----------Distance to nearest lot line_3__.._..__.._ [�^ !`lumber of lines--------.1------------------------Length of each line-------J-9�---------------Width of french-------4-----------.---------.-.- 1� ` Type of filter material----17ae__A-------Depth of filter material-----1-Y- -------- otal length........2_4----------------------------- Seepage --___-__-_______________Seepage Pit: Distance to nearest we4_,_A/a------------- from foundation----f�R-..------- Distance to nearest lot line____,5..____--__- 4 11— Number of pits-------L_ _------Lining material---- ....Size: Diameter------- ____Depth......Z�r---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___....___________.. S ----------------- ❑ Size: Diameter-------------------------------------Depth-------------------------- --- --------------------Liquid Capacity----------------------------gals. Privy: Distance r st well-_----------------------------------------------Distance from nearest building-_.-.--__. ___.-_-__---_..___-__..._. ❑ Distance to nearest lot line------------- -----------------------------------------------•------------------------- ------------------ --------- ----------------- Remodeling and/or repairing (describe}:- ------------------------------------------------------------------------ ---------------------------------------- ------------------------ O -----------------------------------------------------C-1 --------------------- ------------------ --------------- --- ---- . . ------------------------------------------------- ------------------------------------------------------------------------------------------•----------------- ------------------------------------------------------ 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, nd rules and regulations of the San Joaquin Local Health District. (Signed) ---------- . .... - -- ------(Owner and/or Contractor) --------------------------- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - ------ DATE------- - --ef-, ------------------- REVIEWEDBY--------------------------------------------- --------------------------------- --- ------------ ----------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- ---------------- DATE---------------------------------------------------------I--- Alterations and/or recommendations•-------- ---- ------------------------ FINAL INSPECTION BY: C°?1Date X02 -- --- 5----- ---- -- --------------------- SAN ----- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockfan,California Lodi,California Manteca,California Tracy,California F.P.EO.