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VUROFFICE USE: { ' ` ! ----------------- ,�. - _ __-------------- -------------------------------- APPLICATION FOR-SANITATION PERMIT Permit No. .11 ` ---------- --------------------------------------- (Complete in Duplicate) _ - --------- ----- --- -----------L- --- --- -------- I This Permit Expires I.-Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. Ile JOB ADDRESS ANQ LOCATION_ __-.' �_ _ -r-7 c•-a2--�-� j -------------------- ------ '--L --------- ... ----- --' .------------------------------ Owner's Name-------------- i Address------------------- ----------- , �'_�. ...----- - ------ - Contractor's Name____________ _____ •- I Insta11ation will serve: Residence kj-_'Aparfinenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units,,,--/--- Number of bedrooms-7--- Number of baths _7--Lot size Water Supply: Public system'[] Community system ❑ Private P Depth to Water Table ._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam 0 Clay ❑ Adobe [❑ Hardpan ❑ Previous Application Made: (If yes,.dote- -_ ) No New Construction; Yes o r ---- �� I�J ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se er is available within 200 feet.) Septic ik: Distance from nearest well------- Distance from foundati9n--_-_Z*A'_.__ Mater-al _ No. of compartments------------Z _.r - ----------------- ---•----------� -------$ize-- -1-(�-- _ Liquid depth---------- - -----------Capacity---1- Disposal geld: Distance from nearest well----1--o....Distance from foundation-_-_f 01 Distance Distance to nearest lot line-------7 Number of lines--_ ------------- Length of each line- UI :V� Width of ial-._-_.materT of filter trench---. .--J Type of filter material_--- �-j e th �� [ p �--�-- --- otal length---- Seepage Pit: Distance to nearest well----------------- ----Distance from foundation_-----------------Distance to nearest lot line---------_._-_--_ ❑ Number of pits_#----------- -------Lining maferial--.----------- ------- Size: Diameter.------------- -------Depth--------------------- ------ -- r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_----------------------------------- El Size: Diameter.--fi------- ----------------------- Depth----- -----------------------Liquid Capacity---------------------------gals. , Privy: Distance from nearest well----------------------------- __Distance from nearest building-----_--------------------------- ' ' Distance to nearest lot line-------------------------- Remodeling ----- ------------- --Remodeling and/or repairing (describe):-------------------- - -_ i! ---- --------------------------------------- -- -----------------------------------------------------------------------------------------------.------------------ 1 hereby certify that I have prepared f 's.applicafion and that the work will be done in accordance with San Joaquin County ordinances, State laws, yid rules and regu tions of the Sa oaquin Local Health District. •rac By: ------------- - --- -- -•- -- ---- --- - ------------------------------------------------------------------------(Owner and/or Contractor) Si ned _ / Plot fen, showing of to#� ------ ---------------------------------- - --------- Title [ ; - --------------- p g location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......... -�----------- -----------=---------------------- DATE--------,7 /'/' ``r------ ------ REVIEWEDBY--------------------------------------------- -- ---------------- - - ---- --------------------------------------------- DATE----------------- BUILDING PERMIT ISSUED---------------------------------------- - DATE....- Alterations and/or recommendations:____________- ��--- .:¢ - C '' f i - <<= --------------- z r �r �.. -g .:: r - s ---------- -------------------------------------- ---------- - -------------------------------- ---------------------------------------------------------- -------- --------- ------------- ---------------------------------------------------- FINAL INSPECTION BY G 'f rJOAQUIN / —/ �— Date.---- - .... ------------- ----------------------- SA LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street Y^'� 124 Sycamore Street 205 West 9th Street Slockfan,California Lodi,California Manteca,California Tracy,California