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FOTOOFFICE USE; ------------------------------ ------------ APPLICATION FOR SANITATION PERMIT Permit No. 7 ------------------------------------------- ----------- - (Complete in Duplicate) 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 Ordinance N 549. // JOB ADDRESS AND CATION-------------- Gram------------------------- -X -- fJ Owner's Name-.----- -��-7---------rlwla----� - -e-- --- - --------------- - - - -------------------------- ---------- Phone------------------------------------ Address---------------------------- --•---------- Address-------------------•-------••-- - ---------------•---......---------- Contractor's Name---- ------ --•---g �1. �--------------------- -------------•-------------------------------- Phone---------------------------------- Installation will serve: Residence [ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms ----- Number of bath/-------- Lot size -_-----b-> _-X-- ------------- 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 E] 'C1ay Loam ❑ Clay Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------I No New Construction: Yes ❑ No 2-'-FHA/VA: Yes ❑ No 0� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sentic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-------------------_----------------------------- ls�/.-1/J No. of compartments------ -------------------Size--------------------------------Liquid depth----------------------- -Capacity----------------------- Dispos ld: ( Distance from nearest well- "P.-I--__-Distance from foundation---rl-d1........Distance to nearest lot line--- ------ Number of lines------------f------ ---- ___Length of each lire-----;U..--©-_.-----...Width of trench------�D..V- -..----.-.-- Type of filter material--- 1�--�__________Depth of filter material----_-l4-l .--.Total length----------��caL-----�-- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- Ef Number of pits----------------------Lining material-----------------------Size- Diameter.----------------------Depth-----.--------------------------- 11 Cesspool: Distance from nearest well-----------------Distance from foundation--------------- ... Lining material__.----------------._-..---------.--. L❑ Size: Diameter--------------------------------------Depth-------------------------- -------------------.-Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------.----_-----_--_______---.-. { ❑ Distance to nearest lot line------- ---------------- ----------------- --------------------------------- -------------------------- Remodeling and/or repairing (describe):------------4��------ --- -- ------ nGt � ,rr. - -- ---------- ,�1h'' -------------------------------------------- #'V{, -------- --------------------------------------------------•-------- -----•-------------------------------------------------------------------------------------------------------------- ----- ------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law nd rules and radulations of the San Joaquin Local Health District. a (Signed) / ----- --- ------(Ownerr� fand/or /Contractor) (title)------ --- --------- y= (Plot plan, showing si lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- '-------------------------- DATE-------------------------------------- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ ------- ---------------------- Alterationsand/or recommendations----------- ------------------- -------------- ----------------------------------------------------------------------------- ---------------------------------- ------------------------------------------------------------------------------------ -------------•-------------------------------------------------------------------------------------------------------------------------- -----------------------------------•---- ------------------------------------------------------------------------------------------------------ --•---------•--..--...---------------------------------------•--------...... -------- --- ---------- ---- -- ------ - ----- -------------------------------------------------•------------------ • ----------------- ------ ----------------------------- - ---------------------------- FINAL INSPECTION BY: -/A. J --------------------- SAiOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California P F.C13.