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FOR OFFICE USE: y r: ( - -- ------ APPLICATION FOR 'SANITATION PERMIT Permit No. _IJ-------------- -- --------------- (Complete in D iplicafe) / This Permit Expires 1 Year From Date Issued_ 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. JOB ADDRESS AND LOCATIONf,--3-7J �� - - - 7-------------------- ------------------------- - Owner's Name---- ------ •- ------- ---------------- � Ph `{ S Address------------ = --Q------- ------------•-------------------- Contractor's Name--------- ------�-------� ! —r� .. �3�-------------------------------------- Phone Y' --- - k i Installation will serve: Residence E' Apartment House ❑ Commercial ❑ Trailer 'Court ❑ Motel ❑ Other E] Ir ''Number of living units: Number,of bedrooms J----- Number of baths _-E----- Lot size ---J._�_X_�4 _ Water Supply: Public system t❑- Community system ❑ Private ❑ Depth to Water Table --------gift. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay,E] Adobe 2�` Hardpan ❑ Previous Application Made: (If yes,date_."._. ) No New Construction: Yes ❑ 'No [6j FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 4 } (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ha--------Distance from foundation--_l_A--�__.__Material----- ------------ No. of compartments? ____k �------------- ---Liquid de_pth------Y-'--------------Capacity---# �j, . ' Disposal Field: Distance from nearest well.... Distance from foundation----t4..........(Distance -A-- r.------ 't to nearest lot line._5..:____.. Number of lmes3_________-------------_______Length of each line---/_aidth of trench.__-___l-._-1.---._--..----------.- J Type of filter material---1.4—-�-�.--------Depth of filter material-_--./5`' -----_Total length-----L,,-'r-___--_----__--_- ' i , l^'f ! , Q i I- -- Seepage Pit: Distance to nearest we€I ---AV4-.---_,--._Distance from f99unc ation___f______________Distance to nearest lot line_-5.--_-._--_- ea.� '' 1 w [�" Number of pits----Z._----'- Lining material------_.__..._-_.--.Size: Diameter----31..............Depth___--� y-- ----------------.- I ',r � E Cesspool: Distance from nearest well-----------------Distance from foundation---- ._------------Lining material--------------------------- D ❑ Siz Diameter ------------------------Depth---- -- ---- ..Liquid Capacity gals. Privy: Distance from t well-----------------t'"......_._........_._...--Distance from nearest building-_-_----...--_._,---_----_-_--.-_-.------. ❑ Distance to nearest lot line-- -------- -------------- -------------------------------------------------------- ------- ----------- ------- ---------- --------------- --- -------------- Remodeling and/or repairing (describe) --------------------------`-----•-------------------------- -------_--------•--- -------------------------------------------------------- � _______---. .•_ -------- ------------------i- ------!'--------------------------------------------- _--•---- ----- - -------------------------------------------------------------- ;owl---------------------------------------------- ' r -------._____-------------- -----------_----.-------k-------o-------------------•----------'•----------------`-------------- --------------------#---------•----...-------------------------------- I hereby certify that I have prepared this applicationand'+hat'#hewwork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed)------------- ---------- -= --- ---d_4-�.(- -.r' r_---- ---------------- -------------------------------------------- (Owner and/or Contractors i By:------- ---- -- - --- ---- ---------------------------------------------------------------------------- -------------(Title)------------- ----------------------- --------------- ---- (Plot plan, showing size of lot, locati'n of system in relation to wells, buildings, etc., can be placed on reverse side). C._ M x FOR DEPARTMENT USE ONLY APPLICATION ACC_ 1 PTSD BY ------- ---- DATE ---(y- all REVIEWED BY----- ------ ------------------------- ---'-------------------------------------- ----------------r------------------------- DATE--------------------------------- --------- ----------------- BUILDING PERMIT ISSUED------------- - I .. . . ------- DATE------------------------------------------------------------- -------- Alterations and/or recommendafionsi ----- ------------------------------------•--•----- ----------- -------------------------------------`ww _ " ` ------------------------•- ------------------------------------------------------ - ---------------------------------------- ------------- --------•---------------------------------------------------- --------------------- ------ - - --------- -------------------------------------------------------1.1_.11.-------- ----•------------------- -------------- i - - -------------- -------- ------------_------------------------ ------------------ ------ - -- ---------------------- -------------------------------------------------------------- -------1111------- ------------------M---- - ------------ ---i---------_ - ----------------.....------------------------------•-------- ------ - ----------------------------------------------------- rNOAQUIN / FINAL INSPECTION BY:. � ----- Date ;( �S. LOCAL HEALTH DISTRICT 1601 E.Ha:efton'Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street [ Lodi,California Manteca,California Trac l 51e ekton;California '��-` �' Y, California