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FOR OFFICE USE: '-----� --- Permit No. . ---------- ------------------------- ----'------- APPLICATION FOR SANITATION PERMIT ��`�-----•-- ' ------------------- (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 descrbed. This application is made in compliance with County Ordinance No..549.. tom, _ JOB ADDRESS AND LOCATION f..4_g3= - � [ --- R}:--04 - 4� 7�JTjG I Z j OCJ (j Owner's Name------------------------------- --C3��1.---' -"�U_1��------ --------------------- ---------------=Z- -----' - --'-------- Phone------------------------------------ Address-------------------------------••-- l I------ / -- x-------.taiix-------- ---------------------------------------------------------!--�----------•----- •------- ti NexC r 'r0 q Contractor's Name------------------ -_. .� � � `..........---------------- ------------------------------ ---------' Phone.._ .. Installation will serve: Residence {Apartment House ElCommercial E] Trailer Court ❑ Motel ❑ Other ❑ ^,�� Number of living units: Number of bedrooms ---3- Number of baths _ -__ Lot size _ __-Acrq W Water Supply: Public system ❑ Community system ❑ Private 2r-15epth to Water Ta bl Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er--Hardpan ❑ Previous Application Made: (If yes,date---------.----------) No 2---New Construction: Yes E3--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--50-___. Distance from foundation ---------MatenaL__- a ��--- ;- ' No. of com artments------ -- -_.Size------- GAS,_ Liquid depth-----�L-," r)�- --.___.__---CapacitY__) -Y____- --4---- Distance from foundation9O- ____-_.Distance to nearest to line_____ _________ Disposal Field: Distance from nearest well--i5A ❑ Number of lines---•--- ......-__-----------Length of each line--------�0 ._'---------Width of trench---- ----------------'---------'- Type of filter material.__- .Depth of filter material-___ Total _____________�_�____._ f � Seepage Pit: Distance to nearest wwll___-� .......Distance from found ation__-.�-�- -Distance to nearest lot.line----------------- 6 yy 110L_ ❑� g k `9-!'i----- Depth---- --------------- --------; Number of pits_---.___.- _._..._ Linin material__�L .- -_.-.__.Size: Diameter_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------_-___-_ ❑ Size: Diameter------------------ -- --- ----De th-----•-------------------------'------- ------------Liquid Capacity _-------- gals. Priv Distance from nearest well..-.-. -----Distance from nearest building--------------------------------------- -' ❑ Distance to nearest lot line- ------------------------- ----------- ---------------------•------- - I Remodeling and/or repairing (describe):---'---- --------'<- - ---- ---•--------------•----------------------'----------- ------------------------------------ ------------------------------------ ---------------------------------------------------------------------------------- - - -- Sa -qui I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sa s, and rules and regulations of 675an Joaquin Local Health District. ner r Contractor) (Signed)y- _ � ..-�---- (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 q j APPLICATION ACCEPTED J---------------------- -------- ------------------------ DATE 'Q'7h7 - REVIEWED BY-------- ---------------- --- ----------------------------------- ------------------------------------ ------ DATE -- BUILDWG PERMIT ISSU - ------------- ------------- -----------------------. DATE - I Alterations and/or recommendations:------ -'--------- -----•--- -------------------------------•--------------------------------------------- ---------------- ' ----------------------------- ----------------- ------------- ----- - ------------------------------------' N ----------------------------'- -------------- -------------------------------- :- �-. -- - - --- Date... A9:-J04-7-------------- -- ---------------------------- FINAL INSPECTIOSAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocktonr California Lodi,'California Manteca,California Tracy,California n r.t=.r;o. "r•; '*. \:�' _ r• - _ _� ^w -mss !!