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FOR OFFICE USE: ---------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (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 ermit to construct and install the work herein described. This application is made in compliance, 'th ounty Ordinance No. 549. _ 0C it ' Do-i- Al. A Q �,/ p JOB ADDRESS�,AN}D L�CATION------- ------•- L` _- ------ 1 -----t t�_( -�n-----_ -- _ 1�-_ _ Owner's Name,-y t- �� II _Iq �''� 1 n //�/ '� f�40 -- - --- ------ Pho e,41 66j>�- / Address---` �'-`-�-�- �P �+�'- ! Contractor's Name---- ---�__ --- ,._ ..�. -------- ----5-®/V- Phoned?'{� �f7 - .. f Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other)NS040oz— Number of living units: -------- Number of bedrooms ________ Number of baths -------- Lot size ----- --___.,4.CA,_E_.__``-�__------------------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table 60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: (If yes,date----------- ------1 No 9 New Construction: Yes 5Q No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ 0'____Distance from foundation__-�A___r__.___.Material._____--_1�� J_____________ No, of compartments. _ -----------------SLiquid de th_..5_3_.............Capacity-4"- W- Disposal Field: Distance from nearest well_Ze4?—_.__Distance from foundation--60 to nearest lot line._ f✓.Q_`, Number of lines :_ __- Length of each line___fW�__`i_____--Width of trench---;2.4-- �1-----_------------ r r Type of filter material-P-11-.7-MIC--- th of filter material____ - Total length_______ __ __________:__--- Seepage Pit: Distance to nearet well-_2-0.0_------Distance from foundation___1� 2��__.Di to �� to nearest lot linee Number of pits.__ __________..Lining materia l__I 0CAI,—__Size: Diameter._--"_7__ -,-------Depth__-��___________________- ' Cesspool. Distance from nearest well------------_----Distance from foundation____-------------_-.Lining material----------______._.__.________-_____. El Size: Diameter----------------- --------------------De th---------------------- _ ----- - ------- _ --------Liquid Capacity_ gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ____-_._______._____.___________.-_-___-_. ❑ Distance to nearest lot line------------------------------------------------------------------------------------x---------- ---�------------------ ------------------ I Remodeling and/or repairing (describe):--_ _ ��""__._�� ___f. ___ _ _ ^��1•�(�_______ � ------ - -- ° ' - ; hit-c, /�Y� -[ -' - --- --- - ---- p ------------------------------------------------ --------------------------------------------------------------------'---------------------------------.--------------------------.----------------------------------- - I hereby certify that 1-1).ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a7id rles and regulations of the. San Joaquin ocal Health District. { (Signed)-------------------- �/�L/1� =----- --------------------------- ---4-(Owner� - ------- -�..------�'-- --,---------� and/or Contractor) 1 . By:----------- ------------------------ /" ' ! :- __ ----(Title)--------- -- - – – +� (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY:� -__ // APPLICATION ACCEPTED BY------- - ........... . . ----------------------------- DATE--------1 l- -------------------- REVIEWED BY---------------- , ` -- DATE---•-------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------`- ---_- fr'�r DATE ----- Alterations and/or recommendations:_____-.. f� - 4 'LfDATE ------ 4 ______ ___/_-_.__._________._..____.__-r___.__--..__---___--..._._...-----.F...__.----------.----------------------• - ___ _ _ ___ ----------------_--------_----_---------_---_--------------------------------------------_------------------------------------------------------------------------------------------------------------------------------------ .............._-----------_--------_______-------------------------------____---_---_______---------__-----------_---------------------------------------------------------------------------____------------_---------------- 'IV ~'r r f f FINAL INSPECTION BY:._ � - --- --------------- Date-----y'� (Dh--- - ---------------------------- SAN - ------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5tocklon,California Lodi,California Manteca,California Tracy, California F.P.Qn.