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FOR OFFICE USE: V 13Q ._.__.__ _____________ --------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- ---- ------------------- (Complete in Duplicate) 7� 1 ------------------ ------------ - - -- - - - --- ---- -- This Permit Ex ires 1 Year From Date Issued Date Issued ��'_________. _ e35.5— 1?0- C9'. '-1' Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made 1D compliance with County Ordinance No. 549. JOB ADDRESS AN OCATI N-e------------ 1� ,/� i---Q�---- --- - l Owner's Narne__ e r7. �{ 5/ - ---------/--- ------/----------- Phone Address............. ..... - - -••-•---- /�✓ ------------ ---------------------------------- Contractor's Name----- ---- --- ---�---- -•-- ---� --CePhone----------------------------------- - - - - - ----------------- ----------------------------- -- - --- --- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1- Number of bedrooms __ _ Number of baths L"ot size ____-- -�j�_ � � � Water Supply: Public system ❑ Community system ❑ Private epth to Water Table 4�_j fit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loamay Loam ❑ Cla -0- Adobe ❑ Hardpan ❑I Previous Application Made: (If yes,date---------------'_.)' No New Construction: Yes o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: • -(No--septic tank or-cesspool-permitted_if-public-sewer.is-availableYwifhin 200;feef.) *- - Septic T k: 'Distance-from nearest well_-. .___Distance from foundation__49___ Ma erial_i. &F.__ +D/C_� ---------- _ sill of compartments_ - Liquid ciepth._.1CapacitY_ e _-(--' �_ Disposal F- fd: Distance from nearest well__ -------.__Distance from foundation__ _ Q Distance to nearest lot line_z, -- ------------ _ . Number of lines----%3--- � __li _____ Length of each line_!,�� _�_ (f�7-__.Width of Type of filter materiai__ .� ----------------Depth of filfer maternal___: ._ ---------Total length_-_C�.T&e)---------------------- Seepage Number of pifs-------Distance ____________________SeepageDistance to nearest well _ _________ _-____-Distance from foundation. _ ..............Distance to nearest lot line ____.._______.- . .--T- Number of pits------- ---------------Lining material----------.-------__ meter-----------------------Depth--------------------------------- � Cesspool: Distance from nearest well-----------------Distance from foundation----------_------ _-Lining material-------------------------------------- ❑ Size: Diameter-------------------------- ------Depth------------- --------/----------------------- ----- ---------------Liquid Capacity---------------------------gal Privy: Distance from nearest well---------------- -----------------_--------------Distance from nearest building_____,-_.__._._.__________- _-_--_--_. I ❑ Distance to nearest lot line___---_------------_ r ---------------- ----------- ------------------------------------------------------ ` i Remodeling and/or repairing (describe):____.._/29_ J____-_iws9�7/C___ -• f �---------------- ----------------------------------------------------------------- ------------------------------------_•--_-------------------------------------------------------------------•---- -------------------------- ----------------------------------------------•-------------------------------------------- +- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County $ ordinances, St ws, and rules regula+ions of the San Joaquin Local Health District. 6(Signed)----------- L p . -- ------------------------ ------------------------- (Owner and/or Contractor) (Plot plan, showing six of ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY ---------------------------- DATE----- b REVIEWED BY------------------------ ------------------------------- ----- ----- -------------------------------- DATE------ ---- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------- j Alterations and/or recommendations:------------------------------------------------------------------------- -------------------------------------•------------ 4 ---------------------------------------------------- ------------------- ------------------------------------------------------------------------------------------------------ -------------------•------------------ --------------- ---------------------------------- --------------------------- -- --------------------------------------------------- ------------------------ -- P �FJLIAL INSPECTION BY:_ _ - `/e�??i ------ ---------- Date- � ..�_r�i�---•- --------------- ------------------------ -t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklonr California Lodi,California Manteca,California Tracy,California