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FOR OFFICE USE: � ------- .................tk� -._---... ._. APPLICATION FOR SANITATION PERMIT Permit No. _,7_2!1.1.8" - (Complefe•in Duplicate) i -- �' This Permit Expires 1 Year From Date Issued Date Issued A ./_�I Application-is hereby made to`'fhe San Joaquin Local Health District for a permit to construct and install the work hereindescrli ed.- This application is made in compliance with County Ordinance No. 549. JOB ADDRESS'AND'L CATION.------:-m-.---. •---- -s- ------------------ Owner's Name f � ----------- ------- ----------------------------- -------- Phone.._Yj6- Address__..szo----- -- t _ Contractor's -�-�- -- -- ��-----------------------------------'------- Phone-��---��.T Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ j Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms ---/__ Number of baths __/____ Lot size , _ , .7s5-______________________-___.- h Wafer Supply: Public system M Community system ❑ Private ❑ Depth to Water Table °_k_ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El ,Clay E] Adobe,® Hardpan E] kit Previous Application. Made: (If yes,date-- ------)-No.®-- New Construction: YevEl -No-P FHA/VA: Yes ❑ No-E!U TYPE OF INSTALLATION AND SPECIFICATIONS: r ,l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 g Septic Tank: Distance from nearest well-----....._._._Distance from foundation..../_�F__-._ Matenial ...C�77_1_c' ® No. of comartments-._�._.. p ------Size- X_l�1.)C�__--_Liquid depth---6-d.'"--- ------- Capacityr_!go��, -_ Disposal Field: Distance from nearest well..."'__._...-_Distance from foundation....40----------Distance to nearest lot line---- _ Q _...__. © Number of lines ____- _-/-----------------------Length of each line__ _ 0..._.-._..______.Width of french__-__"-/_._____-.-__-__.____ Type of filter material----9_0gf C____Depth of filter material__/6--- Totallength--- 4 _'______________________ Seepage Pit: Distance to nearest well.....................Distance from foundation--------------------Distance to nearest lot line_______________ ❑ Number of pits------------- -------Lining material-------------- ------- Size: Diameter-------------]----- ----Depth----------- --------------------- Cesspool: Distance from nearest well ------ - -------Distance from foundation._......__.-..__ _ Lining material------------- ..'---------------- ...__. ❑ Sze: Diameter. ------Depth.-------- -`--- -----------------------------------Liquid 1Capacity-------------- ------------gals. Privy: Distance from nearest well...------------------------------.------ .......Distance from nearest buildingI ❑ Distance fo nearest lot line--------- ............ I Remodeling and/or 3repairing.(describel:_.. __.__.___ --__--- �,,�,.� _ .- -��-- � __ _ --------- -- - ---- ------------------------- ----- - "- - . �i __ --------------__ __ r ------------------------------------------------ ; .i.. r r 4 I - hereby certify that I hav --------- -------------------- --------------------------`-------------- - -- --------------------------- - ------------- I ,. y y e prepared this application and fhaf 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, I j �( (Signed ' �'f�t��'r"�/ �j - #` -----(Owner and/or. Contractor) By._ _it_. _e----------- -------- —` - ---:. --------- ---- --- ---------------------------- (Ti+le]_�� .. (Plot plan, s owing size of lotllocation of system in relation to wells,'buildings, etc., can be placed on reverse side). FOR,DEPARTMENT USE ONLY APPLICATION ACCEPTED B� -� -- - - --------------_�=---- 7=-*DATE.----- REVIEWED BY---- - ----------------------------------------- ------ ----------------- ---- DATE BUILDING PERMIT ISSUED----- ---------------------__-.- -_-- DATE---------.- Alterationsrand/or recommendations:._.. - d t _ , r - ------------/x.4._.,3_- _. -: .---- -- -- --- --------- ------ ------- ------- ---- ------------------ ------------ - ---- ---------- - ------ ------ --------- ------- - ------------------------------ ----- ----- ------------------ ------------ - _i f ---- --- - - --- -----4JOANLOCAL ------ ------ FINAL INSPECTION Bl f SAHEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street r. 5lockton,California Lodi, California _ Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press