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FOR OFFICE USE: R. - -- --- -------------------- -------_________________________________ _____________ APPLICATION FOR SANITATION PERMIT Permit No. � -------------------------- -----------------_---------- (Complete-in Duplicate) --.--- This Permit Expires 1 Year From Date Issued 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._ ___-- �9/�- �-�-_- - - Owner's Name -------------• - --- -- ------ Phone----------•-------- ,y / Address..---------��- � - .../..�l �f - Contractor's Name 'ls----`� l--S ------------------------ --•--- Phone------ -_-------------------- Installation will serve: Residence ®Apartment House ❑ Commercial [] Trailer Court E] Motel ❑ Other ❑ Number of living units: f-___ Number of bedrooms ___�L-Number of baths A------- Lot size ----- C Water Supply: Public system B— Community system ❑ Private ❑ Depth to Water Table ...... _ if Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe C!f Hardpan ❑ Previous Application Made: {lf yes,date--................. l No 21— New Construcfion: Yes ❑ No Imo" FHA/VA: Yes ❑ No ®r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep#i ank:ij Distance from nearest well_________________Distance from foundation--------------------Material l No. of compartments-------------------------Size-------------------------------Liquid depth -------- ---- -- ------- Capacity----------------------- f Disposa Field;— Distance from nearest well-.---------------Distance from foundation--------------------Distance to nearest lot line----------.._____ Number of lines---------------------------------Length of each line-- ---------------------------Width of french----------------------------------- Type of filter material--------.._____---------Depth of filter material-----------------------Total length-------..--------------------------------- Seepage ._______._______--___------____Seepage Pit: Distance to nearest well---__.'------.....Distance from foundation---/__a-----------Distance to nearest lot line__.___--- ___ [� Number of pits--- ---1--------------Lining material------ v._�('�Size: Diameter-----;;�3-Y------.Depth..2.J-__!------------------ Cesspool: Distance from nearest well ___...._..__-__Distance from foundation__________------ __Lining material-_.-....___.__-._..____..__-_-__--__ ❑ Size: Diameter- -- -------------- -- - - - -------Depth--.----------- -- --------------- -------------...Liquid Capacity----------------------------gals. Privy: Distance from nearest well ____________________________--- ___---------Distance from nearest building___-._-_______________________---._.-.._. ❑ Distance to nearest lot line------------ - ------ - ---------------------------------------------- Remodeling --------------------------------------------Remodeling and/or repairing (describe):-- ------ ----------------------- -----------------------------------------•---------------------------------------- ---------------------------------------------------------------------•--------------------------------•---------------------------------------------------------------- -----------------------------------•----------- ---------------------------------------------------------------------------------------------------- --------------------------------------------- ------------------------------------------------------------- -._ -- I hereby certify that IAiave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an ryi�s and 7,,leflo �helanquipLocal Health District. (,( (Signed) -- ---- ---------------------- - ----------------- -------------(Owner and/or Contractor) By:--------------------------------L-------•--------------------- ----------------------- ------------------------------ ----------(Title)--------------------------.-------------- - - --- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1,14,2,4&FARTMENT USE ONLY APPLICATION ACCEPTED BY z - --------------------------------------------- DATE----- REVIEWEDBY ----------- --- ---- ------------------------------------------------ DATE-- •------------------------------------ BUILDINGPERMIT ISSUED------- ---------------------- -------- ------` -------------._. --------------------------- DATE------------------------------ Alterationsand/or recommendations:---------------------- ----- -------------------- ---•---•--- --------------------------------------------------------------------------------------------- FINAL INSPECTION BY:..---- kJQUIN --------------- bate- S LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th street Slocklon, California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press