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�r FOR OFFICE USE:` '-` ' Permit No. I ---------------- ---- APPLICATION FOR SANITATION PERMIT � ----• --'------- ' --------------------------------------------------------- (Complete in Duplicate) Date Issued, - -------- --------------- -------------`-, This Permit Expires 1 Year From Date Issued Aplication 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. co`r�s /_ -4-1�r —� �►4 MR ------- JOB ADDRESS AND LOCATION-----------------------LQ.3 -- . --------- ?`R ��---------------------------- ----------- ------- Phone. ---- ----------K-0-6i R-r� +� e Owner's Name : t; Address--------------- -p.Q. -------13Qx---------6-`r--7-------------- ------- ------------ Phone-------=-------- ----------------- Contractor's Name------- ---•---------•-•----------------------------------------- - ----- -- .. Installation will serve: Residence Apartment House ❑ Commercial ❑ r Trailer Court ❑- Motel E] Other E] _ Number of baths __. _ Lot size __-_--�-- K----� -•-------- ? Number of living units: _�____ Number of bedrooms _3 �--• Water Supply: Public system Z-11,c-ommunity system ❑ Private ❑ Depth to;Water Table I_ ft. e b oHardpan C1Character of soil to a depth of 3 feet: Sand E] Gravel El San Loam Clay Loam ❑ Clay ❑ Ad ❑ Previous Application Made: (if yes,date--__.__---_-------) No �New Construction: Yes 54-'No El Yes E] No 0� —TYPE-OF-•INSTALLATION-AD-SPEC-IFICATIONS: =j, (No septic tank or cesspool permitted if public sewer is available within.1200 feet. .z �Q Materi IA.wQ_ Septic Tank: Distance from nearest welL_f-��_VV--_Distance from foundation, : _- ---- Yc 4 Ca acct �J No_ of compartments_------2------------Size--- _ Lquid depth__-- --- --�- Capacity i Disposal Field: Distance from nearest 41!w II____�-.111 Distance from foundation________________ Distance to nearest loft line�__r____� J Length of each lin _------ ---------------Width of trench-__-_--a '�'----�.- -----•-' / Number of lines--------- g� - ----- g Il Type of fi4ter material--- Depth of filter materia!_:_' _ -----------Total length-_____= -------- Seepage Pit: Distance to nearest well----------------------Distance from foundation!____`i.----------.Distance to nearest lot line----------------- d i ❑ Number of pits--------------------- Lining material----------------- -----Size: Diameter-------------- ---Depth------ ----------------------- Cesspool: Distance from nearest well-----------------Distance from fou ndation:._.------------_-_:Lining material------------------------------_----- ❑ _De th----------------------------r--- -- ~-----------`-Liquid Capacity------------------ gals. Size: Diameter F _ 'Privy: Distance from nearest well_____________________________ ------------------Distance from nearest building---------------------------- -------- -- �r ❑ Distance to nearest lot line-------- .-___--- -------- ---------- ----- --- -- `-----•---------------- -------------------------- ------------------ -. - - - 't 4 Remodeling and/or repairing (describe):--------------------------------------- -----------------------r ----•------------- ------------------------- ---- -------------- -------------------------------- I ------------------------------- __^1______________________ ________________________________________________ ___________________________ ________________________________________________________________________________________________________________________________________ ------------------------------------ ----------------------____________ r k ' i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin aunty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -- .-.� -- wne rContractor) (Signed)-- ! i --- -------------------- --- r and/or ---------------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - p FOR-DEPARTMENT USE ONLY iAPPLICATION ACCEPTED BY........ --------------------------------------------------------------SATE--------- '� �� ¢---- ------'----------- I REVIEWED BY--------------------------------- ------------------------------------------------------------ -------- DATE-------- --------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------- ----------------------------------------------------------------- DATE 2�---65`-©,K, 7 1Q� I _.(s - N__9A- -------^1 C- gip' Alterations and/or recommendations:-_-_ _ _ -_ -• - ------------------------------- -- --------------------------=----------------- ------ ------------.-------------------- a-off...__[�►_apo mo ----------------- ----------------------------- -------------- --------- ----------- -------- FINAL INSPEC -- -- Date r ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:etfon Mt. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California - E F.P.Cr]. u. 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