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FOR-OFFICE USE: T ------------ ------ --------- .. eP = APPLICATION FOF' SANITATION PERMIT ermit No. -------- (Complete Duplicate) Date Issued r---- ------------_ --- --_-----__.-_. This Permit Expires 1 Year From 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 LOCATION------------- ------------------------------------ -------------- Owner's Name----------M-A,4'; ( -- -'--.. Phone-----•-----•------------------------ Address-1Il_4--L0 C------'. P.�-�n-(xL�'.�---------- -- "'. ----------- ------------ .0r- ------------------------ Contractor's Name.-----.- "---=-------- -------------- -------------------- ------- -- ------... ...------..-" ------ Phone------------------------------------ Installation.will-serve: Residence { Apartment House-[] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ._._ Number of bedrooms __/--- Number of baths ----:�-Lot size ----- .A-a--`�'-Afee - ------------------- Water Supply: Public system ❑ Community system El Private U} Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ❑ Hardpan Q Previous Application Made: (If yes,date------------ ------ ) No42_11_�New Construction: Yes ❑ No FHA/VA: Yes ❑ No ' i TYPE OF INSTALLATION AND SPECIFICATIONS: - f (No septic tank or cesspool permitted if public sever is available within 200 feet.)� Septic Tank: Distance from nearest well----t.s`! Distance from foundation-..12----------. Material?as_e_A:c�..��.�r�.✓��. ` [V]' No. of compartments...--...._--" --_.-__--Size---- ©-_k----o yL-.l< --Liquid depth---------4_.........Capacity._Z_�_sS. ---r---_ tA Disposal Field: Distance from nearest well...P._0__P--_Distance from foundation---_.1.�•.---------Distance to nearest lot line_.' Number of lines--.-__-_-_-(�..-`-2----_-__---Length of each line-..-------- --------.Width of trench.-..--_�.�--------------------- o Type of filter material_ Ory--------.--Depth of filter material---XY-e---------Total length---------to-q------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation....--------------- Distance to nearest lot line----------------- ❑ Number of pits------------------.-.Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- - —_ .....-.w Cesspool: Distance from nearest well ----------------Distance from found ation....-..._-_--_-- ..Lining material--------------------------------- --- . ❑ Size: Diameter- -- -------------- - --- --------•-Depth--------- - -- -- ------------- --------------Liquid Capacity- ------------------------.gals. Privy: Distance from nearest well--- ...---------.---------------------------------Distance from nearest building----------------------------- .-------.-.. ❑ Distance to nearest lot line ----------------- ------------------ ------------------------------•--------------------------------------------------------- -- ---------- Remodelingand/or repairing describe]:--------_-R -------r -is-r/e - M------WH_IC.J......_K A_IS... ----•------- -------------------------------•-----------------------------------------------------------------•--------- --- ---------------- T T - ' - ---- ---------------------------------------------------------------------------- ------------------------------------; -------------------------------------------------------------------------- E hereby certify that I have prepared this application and that the work will b'e done in accordance with San Joaquin County ordinances, State laws, and rules and gulations of the San Joaquin Local Health District. ' (Signed)-- -------- --- : --------------- ---- --- -- -- --- ------------Owner and/or Contractor --(Title -- -------- ----- ------- - - (Plat plan, showing size of lot I ation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t O------- -------- - ---------- DATE.--- -1e 7--- ------ 1 APPLICATION ACCEI?T1rD BY------1t_K`. _ -- -- ' � ----------------- --�--- ---�'-- - REVIEWEDBY------------ --------- ------------------- ----------------------------------------------------------------- ----------- DATE----------------------------- --------------------------- -- BUILDINGPERMIT ISSUED------------ ----------- ------------------------------------ DATE--- --------------------- ----------- -------------- Alterationsand/or recommendations:... ...... ...................--------------------- -------------------- -------------------------------------------- --------------------•-------------------- I ------- -------------- -- - ----------------- ----------------- ---------------------------- -=------------------------------------------------------------------------• .. ------------ -- - - ----- '---- --- ----------- - -------"----- ---------- ---- ------------------- --------------------- - FINAL INSP -- - - �� -�`�-----� .._. Date----------------- ` ------------------- } SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street 11ockton,California Lodi. Californian a Manteca,California Tracy,California F.N.9 2M 1.67 Vanguard Press