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FOR OFFICE USE: YJ .s APPLICATION FOR SANITATION PERMITPermit No. .___!__ .. 1�' ------ - -------- --------- -------------------- (Complete in Duplicate) ___.._._._.____. __ This Permit Expires 1 Year From Date Issued Date Isd 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 AN LOC N--- � ---Z --ll ----------------------------- --------- ------------------------------------•---- ----------------------- y Owner's Name ___. ...... Phone------------------------ ----------- Address------ �.--------- Contractor's Name-------- = r? -Phone -ZI/P/ar.---------- Installation will serve: Residence Pa—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __/--- Number of baths _/__..._ Lot size cos__,��_. 4s __----------------_--.--__ Water Supply: Public system D_-Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ER---5ardpan ❑ i Previous Application Made: (If yes,date--------------------I No g3�,_ New4Construction: Yes ❑ .No R---_FHA/VA: Yes ❑ No Kj— 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____�_______Distance from foundation-��_._.__.. Mafier'ai_�...---- ----------------------------- gra No. of compartments----�-----------------SizeC45 K 1_`°___Liquid depth.-Disposal Field: Distance from nearest:weld---__--- ._._Distance from foundation u� ---_____.-._Distance to nearest lot line_e�_- Number of lines--- f_._ ®� �_/._ Length of each line__ . _Q Width of trench.�__ ___________________________ Type of`-filter material V/�.Depth of filter material_..,1 ��___.Total length--_"� _`------------------------ Seepage Pit: Distance to nearest well------- ..._...._Distance from foundation_165_;��_______.Dis`7 ce to nearest lot lie--6- ®� Number of pits---- /--------------Lining material_,�k9z: �___.Size: Diameter—EY__ .__.____.Depthr`�rl._.� Cesspool: Distance from nearest well-----------------Distance from foundation......--------------Lining material------ In ❑ Size: Diameter--------------------------------------Depth----------- ------------------- _--- -------------Liquid Capacity- --------------------------gals. Privy: t Distance from nearest well------_------------------------------------------Distance from nearest building------------------------------------------ 114 ❑ 'Distance to nearest lot line- -------- --------- ------------------ - ----------------------------------------------------------------------------------------- --- -- Remodeling and/or repairing (describe):------ -- -- ___.. . - ------- _. _ __ _ -------------- t ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ---.-______________ or Contractor (Signed) - - -- -- -------- ---- (� BY:-------------------------- -------------(Titley_ ----------- - - - ------ ---- (Plot plan, showing size of lot, location of system in rela to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - ------------- DATE------ --- -------- ------�-.`5.---- ------------------ REVIEWEDBY------------------------------- - ----- -------------------------------. DATE---------------------------------------------------------- BUILDING PERMIT ISSUED---------------------- DATE----- ------------ ---------------------- ------------------- Alterations and/or recommendations:_..___ ./a `_. .rcc� ---------------------------------------------------------------------- ------------------------------------- --------------------------- - - ------- -------------------------------------------------------------•------------------ FINAL INSPECTION BY:A1rf�------------- ��/� ..-------- Date-----_-----: :------------ -- i SAN JOAQUIN LOCAL HEALTH DISTRICT. 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stocklon,California Lodi, California Manteca,California Tracy,California F.P.CO.