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K.)KUFFI ,k Ust: q 4 ..................__-_._ -___-------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. _-------------.___.-- (Complete in Duplicate) Date Issued r � J _.................................. �.__. This Permit Ex ores 1 Year From Date Issued osg - oev--ze Application is hereby made to the San Joaquin Local Health District for a permit to construct anq install the work here' scribed. This application is made in compliance with County Ordinance No. 549. p' JOB ADDRESS AND LOCATION--- Owner s OCATION--_Owner's Name__ - -------- PhoneL'Z-- Address --------------------- --- ---- Contractor's Nam - �..4 ----------- --- Phone. Qs�t--� jL r Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a Number of living units: I----- Number of bedrooms Number of bat s Lot size -------------------------------------------------------__+ Water Supply: Public system ❑ Community system ❑ Private epth to Water Table - ft. I i Character of soil to a depthof 3 feet: Sand ❑ Gravel ❑ Sandy Loamy oam ❑ Clay ❑ Adobe ❑ Hardpan E] .� Previous Application Made: ;`(If yes,date._-.--_:.------- No ❑ New Construction: Yes ❑. NoHA/VA: Yes ❑ No 0 TYPE OF INSTALLATION AND-SPECIFICATIONS: 1_ t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e: Distance!from nearest well-----------------Distance from foundation--------------------Material --------------------- -- No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----- osal ie Distances:from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_.__--_.--------- I b 'sof lines------------------------------ ----Length of each line-----------------------------.Width of trench--------------------------------- i ype of filter material___----i�._.�._Depth of filter material-----------------------Total length--__._._---_---__--_----__--..__________- 1 Seepa Pit: Distance'to nearest well_ x,1._0__-----Distance from foundation_-f�-� D�fance to nearest lot lin`Y�-� Number.of pits-----I---------------Lining material_O Size: Diameter�p__ ole___Depth-----f2_._.--------------- ii Cesspool: Distance' from nearest well----------------- fro oundation.__.-.----_.----.-.Lining material--- i -----------Liquid Capacity---------------------------gals. ❑ Size: Diameter--------- ----- �------.Depth------- ---------------------- --- - - Privy: Distance from nearest well ______-------_------ ----------------------------Distance from nearest building----------------------------- --- � ,�•❑. Distance n fo nearest lot line---------------------------`------------ =:: .,,�.. Remodeling and/or repairing (describe):--------------------------- - = ___ ___________ __ _____ _______________ _ __ _ -! ___--------- _:_ _ ____ ___ _ _ a--------------------------------- ---- -------------------------------------------=------------------------------- --- - ------ --- ----------------------------------------------------- ----------- ---- -- I hereby certify that I h'2ve prepared this app ication and that the work will be done in accordance an Joaquin Count ordinances, State laws, a�)-ales and regulations of the San Joaquin Local eaith District. 1 �' -- - - ----------------------------- (Signed) Y; d :f ig *ells, �-: - ontractorBy:---9RF_ET1-Q---T:ANA---S_ERIC]C_a---------------------------------- -------(Title)------------------------------------- - ------ ------ --------- (Piot plan, sgf&`ln�gP'o "C$tIdtefiori of system in relation toldings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --------------------------- DATE- '" �= REVIEWEDBY------------------------ ---------------- -------------------- -------------------- -------- ----------------------------- DATE-------------------------------------------- BUILDING PERMIT ISSUED."------------ ---------------------------------------------------------------------------------- DATE------------------ Alterations and/or recommendations------ - ------------------------------------------------------------------------------------------------------------------------------•----- ------ II ------------ -------------------------------------------------------- -- --------------------------------------------------------------------•---- ------------------ --._..._ ....... -------•--- i� --------------------------------------------------- -----•------------------------------------------------------ ------------ II --------------- -------------------------------------------- --------------------------------------- FINAL INSPECTION BY -I' �- - G SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California F.R.CO.