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'1-UK UrH : USS. J --------------------------- -- \ ------------------------ a /I--.- APPLICATION FOR 'SANITATION PERMIT Permit No. � -------------------------- ---------------------- (Complete in Duplicate) Date - ------------------------------------------------------- This Permit Expires i 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 No. 549.y� ,C{ �f JOB ADDRESS AND LOCATION------�j--�--�------ �- f Cs j? ( ' 5/ ilf/,9, Re p --------- Owner's Name----.D-P-v l lase h l e t��--------------- ---------------------------.-- Phone---L--�'3-�_U_C�� Address Sed4 S�9tp-- ---�-------- Contractor's Name � �"-IY! ---------C j� - - -•e W e ----------- Phone.. - �.! �< ------y------ Installation will serve: Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other F1Number of living units: --j-- Number of bedrooms a___ Number of baths __/-_-- Lot size -1 1� _--_�!-__ � Water Supply: Public system ❑ Community system ❑ Private,k Depth to Water Table 11 ft. u/-el) a? 4- A79,-Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe de Hardpan ❑ Previous Application Made: (If yes,date--------------------) No-W New Construction: Yesx No ❑ FHA/VA: Yes ❑ No>( TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se eis ava lraE b a within 200 feet.) y(_ Septic Tank: Distance from nearest well____ *� `t �� G _____:Distance ro foundation___ _______________Material__/-_---__--_________________-___ No. of compartments----------- ----------Size--------------------------------Liquid depth--------------------------Capacity--1?-- a Disposal Field: Distance from nearest ell... Distance from foundation/V72?�--.Distance to nearest lot line �____..__. Number of lines_-____-:--% -- ----- ---------------Length of each line__.__ Width of trench-----i _--______-_.__ Type of filter material___.l_7_/TcC- --Depth of filter material-----f_F___f___-.Total length--- Seepage Pit: /,�-�jsit�n �� e #t-______________Distance from foundation------------.-------Distance to nearest�ol ❑ �IfU '�umb r of pits------------------ —Lining material--------_--------------Size: Diameter-----------------------Depth--------------------------------- ( ` Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------___---------------__________-El \mak Size: Diameter--------------------------------------De th---------------- ------------------ -----------Liquid Capacity----------------------------gails. �l) Privy: Distance from nearest well-------------------------------------------.___-Distance from nearest building____________________-----_______-__--- El Distance to nearest lot line-----------------[--------------------------- f---�---]---------/------ ------ ------ - ,-[------------------------------------------------ Remodeling and/or repairing (describe): - ,s �v `" 5/i y�� /__ __ '______c-- 0 r � e " . • - t H ---- -- �'cirr p ��t °. .s ee ") /� --2 1 ---------------------••------------------------- ----------------------- -- - --- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .1 hereby certify that I have prepared this a plication and that the work will be done in accordance with San Joaquin County ordinances, #e aws, and rule an re ion. of the San Joaquin Local Health District. (Signed)------- ---- ------- - ----- ----------------------------------------------------------------(Owner a+ad/er-A&otoractbry-) By:------------------------------------------------------------- - --------------------------------------------------------------(Title)---------- ---------- (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 ref.j'!- `} %C--+ ------ ---------------------------------------- DATE_ REVIEWEDBY-------------------------------------------------- - ----------------------------------------------------------- DATE--------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------- ------------- DATE---------------------------- -------------------------------- Alterations and/or recommendations------- --- ----- ---- ---------- ---------------------------------- -------------------------------- Vz ----------- ---------- ---- -------- - ----------------------------------------------------------------------------------- --------------------------------------------------------- ---- ------------------------------ FINAL INSPECTION BY:-----.-- .. -- --- --- Date------------- --`---i-----------�----l--- - - --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:sllon Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktan,California Lodi, California Manteca,California Tracy,California L. F.p.CO.