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'- �1-UZ rFIC,E Q E: i - ----------------------------- ------------------- - -----------------------------1r-- APPLICATION 1=6R SANITATION PERMIT Permit No. ...._._._.____-•-- .... -------------------- ----------- ------- -------- _ (Complete in Duplicate) p --- .-� This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for aconstru t to ermit This application is made in compliance with County Ordinance No. 549. p c and install the work herein described. t JOB ADDRESS AND CA 10 Owner's Name-- 'll ----------------- Phone--------------- ---•---------------- Contractor's Name---------- -r1 1 /--- --------•--•------------------------ Phone---------------•--•---••----------- Installation will serve: Reside Wl\partment House om rcial Trailer Court E] Motel [IOther E] Number of living units, Number of bedrooms -------- Number of baths -`-.. Lot size Water Supply: Public system ❑^ Community system ❑ Private [L?-15'epth to Water Table Aq f�t. Character of soil to a de th i5f 3 feet: Sand P JI ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @9-"nardpan ❑ Previous Application Made: (If yes,date....................) No [ New Construction: Yes �Q ❑ FHA/VA: Yes k]rNo El TYPE OF INSTALLATION AND SPECIFICATIONS: M { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tana Distance from nearest welf--------- Distance from foundation___________________ Material No. of c impartments- ------ ? A-------Size--- -------------------- Liquid.de to Capacity_ 1 1 i ----- Pacit ; Disposal Fie : Distance from nearest weft. ----_Distance from foundation.- 4 - __ ___.Distance to nearest lot line____________ �c+f Number of lines___.__-Z-- `- en;th �of each line___ � ---- ---- 9 � � - --------------Width of trench-.2-- ----------- ---------- � f: Type of filter materiall_/� _E epth of filter material-- p----Total length____��-_� eepage it Distance to nearesf well__,/A0._ ___Distance from foun�afion_ 'lle� - ,/'rQ�___.Distance to nearest lot line_____________ _ �� Number of pits___..____---__:Lining material-- �'t Size: Diameter__ '____.Depth_Q?j---/>C��& Cesspool: Distance from nearest well:?___________Distance from foundation________________._.Lining material-_.._____---__'.____.____________--. 1 �: it ❑ Size:- Diameter----- -----------'--.-----�------- Depth----------------------------------- ------ -- --Liquid Capacity-----------------------------gals.(Privy: Distance Distance from nearest well _.�..___ ______________...._Distance from nearest building i g--- -------------------------------------- �._. �..- �� ❑ Distance t� nearest lot line------------------ Remodeling _________________Remodeling and/or repairing fclescribe):----- AT4_1 � ?---------- of /_ y r ------=------------------------•--------------- t---------------------------------- --- -- -- -------------- =_ ----------- -----------•-- ------------------------Q --------------------------------------------------- -------.--------- -----:-------- —1 ------------------------------- ------------------------ -- �k I hereby certify that I ha a prepared this application and that the work-_will be- done in accordance with San JoaquinCo#nty' ,} ordinances, State laws, and rules and regulations of the San Joaquin � Local Health District. j (Signed) - �� r By: f ` - -----------(Title)-- ✓----------- - (Plot plan, showing size of loth location of system ation to wells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY it A�i � �. APPLICATION'!ACCEPTED BY------ - -- ------------- -- ---- --- DATE------ - r f - - " REVIEWED BYE' IIIA--- --�-- - .- >, --- - ---------- - ------------------ DATE------------------ •-------- ----------------•------------ - BUILDING PERMIT ISSUED �i�l ----=-. --- �, DATE- ' Imo. �- AI#erations a d/ or recommendations: _�_ _� C' ��✓� �c f ------------ ------- t? ------ ^� �x .. � ... , --------------- -------------------- - FINAL INSPECTION BY:.... __ } - ------------ Date.---- - 1 SA J IN LOCAL HEALTH DISTRICT 1601 E.Maselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,Stockton,California - ' Manteca,California � Tracy,California I F.P.0 O.