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rUKUrt-K-L USE; „ �•-- �� } ------------ -------' -----__-_.___.__-.___.._________- APPLICATION FOR SANITATION PERMIT Permit No. ,(Complete in Duplicate) %l � cS�J`rJ ----------------------------------- :------- --- --- This Permit Ex Date Issued/�-: fres 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 here described ^,y A This application is made in compliance ith County Ordinance No, 549. �2 0.2:5"O_ �►/ _ JOB ADDRESS AND LOCATION__ -#� _ Owners Name----- - � _- '-.. .�.. - ----- ---• ----- --- ` _ _p - -_ Phone-------------------------------- Address --------- - ,..�/ - ------ ----------- --- ------- ---- --- -----------• ----t-------...-----•-----_ ----s---.------ Contractor's Name___---_ f ' ' ,�/ r ----------------------------------------- Phone.. Installation will serve: Residence LY1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ Number of bedrooms __umber of baths __ -- Lot.size -----�,1 Water Supply: Public:system ❑ Community system ❑ Private ------- ----------------- EeDepfh to Water Table ._____-. ft. I } - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe Hardpan ❑ Previous-Application Made:-•(•Ifryes;-date'::_.-_ _) ..Nom �..•--New-Gonstruc#ions Yes-[g.-Nor❑,FHA/VA::Yes_❑ -1Vo ❑;�� TYPE OF INSTALLATION AND SPECIFICATIONS: r { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic ank: Distance from nearest well____ -__Distance from qfoundation__-- --- -.Material_._-`_. -,------ t No. of compartments--------- depth__-_.__Sl_ :r ---------Capacity--f '' , Dispas field: Distance from nearest well-, -__--Distance from foundation___-.� /------Distance to nearest to li Number of lines______--_. -------------"-Length of each line-___ 52� -------------Width of. french--- Type of filter material__..?'_ .- Depth of filter material-___- 'n Total length---- � --f o----• aSeepage Pit: Distance to nearest well_____________________Distance from foundation___..______-______-.Distance to nearest lot line_______.________ ElNumber of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth--- --------- Cess" Distance from nearest well_______---__-- _Distance from foundation.-----_--_-_- - ----------- _-._...Lining material-------------- -- ❑ Size: Diameter------"------------------------ ------Depth------------- -------------------------------=-----Liquid Capacity-'------ -------------------"- -------------------gals. ❑ Distance to nearest lot Gne_________ ____ Prie .Avy: Distance from nearest.,well---"__-_______________-------------- - -----_Distance from neares#.buifdin g------ ----------------------------------- :_ ._ - - - ----___-_ a -------------------------------------------- ---------------------------- Remodeling and/or repairing (describe):_-__--- -- r ---------------------------------------------------------------------------------------------------------- -------------•----------- --------------- __________ __ ____________ _ ----- Ihereby certify that I have prepared this ap fication and that the work will be done in accordance with San..loaquin County ordinances, State law , d ules and regula+i s of a San Joaquin Local Health District. --. .. .. (Signed)- ------ -=------- =_ = - " , = By--------- -- ------ -------- r , - - - -1---:_'--"-----�-- � -,and/or Contractor] - - -- = 9------------------(Title)-------- -- -------------------------.. --- ....... (Plot plan, showin size of lot, location of,system in [at ion t ells buildin s, eft --can'be placed on reverse side). FOR DEPARTMENT USE ONLY T APPLICATION ACCEPTED - -BY _ _ -_ ' DDAATTE__/ '_--REVIEWED BY ---------- ---------------- - -- --- ------------------BUILDING PERMIT ISSUED____________________ I A aerations and/or recommendations:-______-- ------------ - > , ------------------------------------------------ -----------------------------------------I------ -------------------------- -- ------------- ---- ' i v _ ----------------------------------------------- ------------- --- f FNAL INSPECTION _ SAN JOAQUIN LOCAL HEALTH DISTRICT ! 1601 E.Hazelton Ave. - 300 Wes?Oak Street 124 Sycamore Street ' 205 West 91h Street Sfackton,California Lodi,California Manteca,California Tracy,California E5 9 REV156O B-59 :3M 3-'63 F-p•CC.