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FOR OFFICE USE: �# ----------------- ------------------- -- ----- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------- ----------------- --------- r "� : .(Complete-in Duplicate) ---- ... This Permit Expires 1 Year From Date Issues! Date issued Application is hereby made to the San Joaquin Local Hea4h District for a permit to construct and install the work herein described. This application is made in,complian with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ ® •two 0 _ C - .A,, - .�. fi �r Owner's Name �. - ------------ Phone-----•------------------- --- Address-------------------------- .� LTJ- '--`• + y Contractor's Name___._. .._. '71st/4 1 � = c U_ ..--------- ------ --- Phone %.lz.---.-....�[�cc,l-------- Installation will serve: Residence Apartment House ❑ Co ercial El Trailer Court El 'Motel [I Other E]r. s Number of living units:.__ ----- Number of bedroomum,ber of baths-f-_-_ Lot size ..../9_IZ- 0----- ------- r i Water Supply: Public system'❑ Community system ❑ Private Z -Depth to Water Tab)eoo _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [0' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:. (If yes,date_.. ............ ) No 0 New Construction: Yes ❑ No Ff 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--- Distance from foundation--- ------------Material No, of compartments............ ..... -------Size-------------------- -----------Liquid depth__.------ ------- - Capacity - _00-------- r Disposal Field: Distance from nearest well--_5JP------Distance from foundation._Ac>___-.._....Distance to nearest lot line---1-10-._-_-. .� Number of fines._.______,�.._-___�___-__._-_Length of each lin .�"'..JQ----.�_---Width of trench---------------- Type of filter materiaL_C[ 1�._:..___Depth of filter material_______________________Total length___- --------------------------- Seepage Pit: Distance to nearest well_._.] __. '___Distance from foundation__J/--__-_Distance to nearest lot line_��7___-___-- - Number of pits__. ----.___--_-Lining material_ c-k--____- Size: Diameter_-.. 2_--------Depth_.1-S ---------------------- Cesspool, Distance from nearest well ----------------Distance from foundation.-__............ ..Lining material_.-__.________.._._-__ t �r Liquid Capacity ❑ _. Size: Diameter- -- -------------- ------- --- Depth,- - --------- ----- -------- - ---- q --------- --- -------------gal Privy:' Distance from nearest well_____________________ _____-_.Distance from nearest building, ❑ Distance to nearest lof line ............... `-------._-------____-- Remodeling and/or repairing (describe):--------- ------ ----------------- ---------•----------•-------------------•--- --------- ------------•---------------------------------------"------------------------------- ------------------------------------------- - ------ i -- ------- ------------------------------------------------- - - ereby certify that I have prepared this application and thaf 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)---- .1__. j P.LkA-------- - ------------------ (Owner and/or Contractor) ------------------------ BY:-____ _o..... ------------ --- -------------- -- ----- �r (Title)._ (Plot plan;showing size of lot, location of systemin relation to wells,""buildings, etc., can"be paced ors"reverse side).- DEPARTMENT USE ONLY +. APPLICATION ACCEPTED BY------------ - C� i ----- ------ DATE- r �'�y---- -- -------------------- REVIEWED BY------------- -------------------- DATE BUILDING PERMIT ISSUED-------- ------------ - p Alterations and/or reco mendations:___.__.. _ --- ---� ------------ • ---- --- -------- �] - --- r-- ----�---- �. i___________ __AL_..___. ...._- 4 -----_/ -------- -----------__.._.- -_.. --.--- -- _ "FINAL INSPECTION BY:_... (ff -------------------------- Date.......4j//7-/�-y7-._. SAN JOAQUIN LOCAL HEALTH DISTRICT 16011.Hazeflon Ave. 300 West Oak Street 124 Sycamore street" 205 West 9th Street Slocktan,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press