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FOR OFFICE USE: f� [ 11-�------------------ -- ......................................... ........... - APPLICATION FOR; SANITATION PERMIT Permit No. .. s.�9.._. --------------------------------------------- --------- (Complete-in Duplicate) Date Issued X 67 -------------- --- ----- -------------------------------- 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... /J.. .Gr.`0--------- . ---- r---- r� ¢��, Owner's Name Z� � -'- ------ ---- Phone--------------------------------•--- ----- ---------------------------------------- Address---------------------------------------- 9 ° Contractor's Name------ ------------------ c =--• ---------------------------------- ----------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. ..... Number of bedrooms _- -- Number of baths .:. Lot size ----- - .f-_.X.-I-T-o--------------------- Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table Pit Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan ❑ Previous Application Made: (If yes,dote--...--- .......... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ( o septic tank or cesspool permitted if public sewer is available within 200 feet.) c rT 'at h Distance from nearest well-----------------Distance from foundation------------- M terial No. of com artments-----_---- ..........Size--------------- ark P Liquid depth- dcc CpacitY UisposI Fi Idl: Distance from nearest well....-------------Distance from foundation-------------------- !stance to nearest lot line_..............-. � I +y7 Number of fines--------------------- ------------Length of each line.- --------.----------------- Width of trench-------------------.----------- --- / ' 1 Type of filter material-------------------------Depth of filter material..............._...-.-Total length-------_------------ ----------------.-.-. Seepage Pit; Distance to nearest well---------------------Distance from foundation------------------- Distance fo nearest lot line..-..-...--...-.- ❑ Number of pits--- ------------------Lining material----- ------ Size: Diameter------------- - ---Depth--------------------------------- Cesspool: Distance from nearest well ----------------Distance from foundation-------.--------- ..Lining material--.....----------------------.-.-- V ❑ Size: Diameter- -- --------- --..Depth------------------------------------- -- -------Liquid Capacity------------- --------------gals. \ Privy: Distance from nearest well-------------------------------------------------Disfance from nearest building.--..--....------------------------------- ❑ Distance to nearest lot line -- Remodel! and/or air ng (d, 'es - 'l h --------- i lC--1--•-------.. l �� ` / / ��Q 1/ -------------------------------•------------------------------------------------- ------- ------------•----•------------------------------- l- - - -------------------------- ------•-------------------------------------------------------------------------------------------------------------------I--------- I here:y certify ha+ I have reparec( 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. (Signed} - Cd --------- ------ - -- ---- - ----(Owner and/or Contractor) BY:------------------------------- ----•-••-------------------------------------------- -------------------------------------(Title)------------ - - -------..------------ --- - --------- (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY =------- ----------------- DATE Ihf1. REVIEWEDBY------------------------ - ..-- ---------------------------------------- ------------------------- ---- DATE----- --- BUILDING PERMIT ISSUED-------- -- --------- --------------------_......------------------------------- DATE Alterations and/or recommendations:----------------------- - ------------- ------ ------------------••-------------------------------------------- ---------•--- ------ ----------------------- ----•---------------------- ----I:---- ----------- ..--------------------------- --- -- .-------------------------------------- ----------------- -----------------------•- ------ --- --------------- --------- --------------- FINAL INSPECTION BY:........... - -- —---- -------- ---------- Date............&7./13� AN A LOCAL HEALTH DISTRICT 1601 E.Hasdton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street $locklon,California Lodi. California Manteca,California Tracy,California E.H.92M 1-67 Vanguard Press