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FOR OFFICE USE: fie- ��"� / �G----- -- 0 APPLICATIONS FOR SANITATION PERMIT Permit No. _.. ...� --------------------- ------------------ --------- (Complete in Duplicate) D / ..-._.----_ This Permit Expires 1 Year From Date Issued Date Issued ____.____7l. .__&- 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 compliancee'�w_i,tth County Ordinance No. 549. JOBADDRESS AND LOCATION.. .... _`� iL' ---------------------------------------------------------------------------------------- Owner's Name -�/ `' � -------------- `1D � === - Phone-/ Address__..------ '--- -�--�--- -------✓ ---u-� ------------------- --------------- _r a x T Contractor's Name-- � "= � ------------------ Phone..__ ...----•--•------------------- Installation will serve: Residence [�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ?-Number of living'units: J.___ Number of bedrooms -- Number of baths I-__ Lot size --------/---------•----------- f G Water Supply: Public system l�Community system ❑ Private ❑ Depth to-Water Table -------- ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0- iaardpan ❑ Previous Application Made: (If yes,date_ _______________I No M—INew Construction: Yes 2-- o ❑ FHA/VA: Yes ❑ No Ilk. TYPE,OF INSTALL-ATION AND-SPECIFICATIONS:,- - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .]- - Septic T k: Distance from- nearest welL__n_�-__`tJigtance from foundation---[/___a-_____...Motel--o-�_--------- _______ _------------ ____ Ca acit �1 _ No. of compartments-.-----.-? ------size_��__�l`_� --Liquid depth------- ------------- p t 1 �J Disposal Feld: Distance from nearest well--------------_'Distance from foundationj_-.,-�.._:__,Distance to nearest lot line_-_-: _________ Number of lines_____.__ __,Length of each line d: �--�p idth of trench.________ Q/' /T g r------------------ Type of„filter material___�"C_1�_c: ,/Depth of filter-material. _-_-/X_`r______Total length---../ __-__________________ r 1.; r e—Distancefrom foundation____._ ___d�.___.Distance to earest lot-line Seepage t Distance to nearest well--n __.-__...___ - ` ' Number of pits.---------;2�------Lining material__ke_C-t___Size: Diameter______ ________ epth_._.-.------------------------ Cesspool: # Distance from nearest well-----------------Distance from foundation____----------------Lining material__..____.__.----________._:.-_--_____ : 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):--------- ----------------------. -------------------------------------- --------•-• --------' ---1---------------------------------------- I , ----------------------- ---•---------------------------- --•-------------------------- -'- ------------------ _ W ----------------------------------------w--------------f ------------------ ------------------------------: - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances, State I S. and rules nd regulations of the San Joaquin Local Health District. [Owner and/or Contractor) [Signed] i 7-t ------------i- --------------------------------------------------=---------------------------(Title)---------- ---- . - -- ------[Plat plan, showing size , location of system in relation to wells, buildings, etc., can be,placed on reverse side). , . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- � DATE ' _ r. REVIEWEDBY------ - ------=------------------------------------------- DATE-------- ----------•---------------------------------------- BUILDINGPERMIT_ ISSUED------------------------- ------------- ----,---------------------=--------k--------------- DAT ------------------------------------------------------------- Alterations and/or recommendations:.-____. .. -�` `- `� 1JQ' `-` �--f ------ -'E �v—sem �a�r-C_ x: ............. +� � ...... --------- f`�'' '_L rS�7�---------------- - -- --------- � :f r- ',h-�—/�-� �# 5, ��, �L FINAL INSPECTION BY:_----------------------------------- �C Date-- /D --- � ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave,. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slotkton,California Lodi,California Manteca,California Tracy,California : ES 9 REVISED 13-59 3M 3-'63 F.P-CCI. - �.+" rr<...•-•- -