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FOR OFFICE USE-.A- ------------............... Permit No. ---------- ---- -- ------ - - APPLICATION FOR SANITATION PERMIT - - --,--- ------_- (Complete•in Duplicate} Date Issued �• --- -- --- ------ a This Permit Expires 1 Year From Date Issued I Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loca This application is made in compliance with County Ordinance No. 549. "T' N N -------- 3 - JOB ADDRESS A D OCATION------- - . Phone A Owner's Name----- -------�-�-. _� ------ - --- --------------_----- Address . -- . Qw •-----------• --------• --- Address------------- ----------5---1 ` iPhone---------------------- ------ { Contractor's Name---=•-- 4'...1 -••---------- ------------------------•---------- ------- I Commercial Trailer Court [] Motel [I Other Ll Installation will serve:.; Residence ,Apartment House ❑ rooms - Number of living units: -- ----- Number of bed � - Number of baths._ _ Lot size _-.__ _ .--_- _E' ��------------------- Water Supply: Public system F1 Community system ❑ Private [ 2 Depth to Water Table - ft Character of sail to al depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam El Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ u _ _ �_� Previous Application Made: (if yes,date_.---- .---- l_No ®�NewConstruction Yes �No ❑ FHA%VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-- S p. Distance from foundation-.L4--------- ater- -.�°_h 1r' �� , opacity No. of compartments---------- -- ---- yy d - ----Size-----.l��-- �-�-----Liquid d�p. --- - Disposal Field: Distance from 'nearest well-I--- .� ...Distance from foundation __-_Distance to nearest lot line_, {-'.- _ " # _ _,R. too -r- --------- . �`i�l�mkier•..ofrlir.les,.--:--_--=-_1-------_�-`== - ;Length oar each. line--.. of-----a------ ----- Width of trench-.-------- -- ------- . �. ..- {_ ,ype of filter material-__- .Virpth`�of filter:�mtenal.- L`^'��L=-Total length ------.--- "1 �Oa--_.-----Distance from foundation.-- _ __ - . Distance to nearest lot li Seepage Pit: Distance to nearest well- ne__ .------ t �❑/ iepthO-. b Number of Lning materiaSi Diameter - ji �c / --k ---- Cesspool: Distance from nearest well ----------------Distance from foundafion.-..-.----------- --Lining r5ize: Diameter- -------- --------._ - De th-------------- --------------------- - ------------ qipty-----------------_-_-0_-D_-c_----------------------------- _ y gals. ----------------------Distance from nearest buildin Privy: Distance from nearest well ----- ----- ---- ----- -- 9---------------------------------------- A. ----------- ---- - - . •_i ___ _.. _iv -- - ---- ❑ Distance to nearest Ic�#��line --_------_--- =-=-- ----- ----- ----- ----'------ -- % { 1�1 I Remodeling anc3/• r repairing (describea--------- ----------- ------------ ------------------------------------------------------------ ----------- ---------------------- ---------------------------------------------- 1•--------- ------------- - .-. t •I__ --"-------------"-_-_-.-_---_.--"------------.---------.._---------.-_---.---.-----------.-------------_-----.-..--------.-...-...__.------ I hereby certify that I have prepareFd this application and that 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. R -------------------_----------------(Owner and/or Contractor{ I (Signed)- f } Title BY:--------•----, -------------- ---- --------- ----- F k (plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i - - - FOR DEPARTMENT USE ONLY -- i ' t DATE-/ ----------------- -------------- - APPLICATION ACCEPTED Bl(�� DATE-------------- --------------------------------------------- REVIEWED BY - M-- - - - BUILDINGPERMITJISSUED-------- -- ----------------------------------------------------------------- - --------- DE Alterations and/or recommendations:------- .-'---- -- -------- -----------"--------------------------------------" •-----•------- ------------•------- -------------------------------- Tn i i - - ----------------------•---------------------- �. .. •------ ---------------------- ---------------- h -------------- ----- --------- -------------- --------- ------------------------------------ - ---'-- ------- ---- Date------.. FINAL INSPECTION BY:---------- = - ..-- -- - S QUIN LOCAL HEALTH DISTRICT 1601 E.Halolton Ave. 300 W s ak Street 124 Sycamore Street 205 West 9th Street Lodi. California Manteca,California Tracy,California i Stockton,talifarnla L` E.H.9 2M 1-67 Vanguard Press