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a? �. _ �i �> ----- ------- = J rPLICATION FOR SANITATION PE�'IT Per 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 constr tpad install the work herein described. This application is made in compliance with County Ordinance No. 549. i rr ' JOB ADDRESS AND LOCATION_.J_4'_7©/ � ` � ��/J� - ------ Owner's Name-------- ICL�'�_--rn ----------�------------------------------ Phone �� c Address........--•.4�7i-1-....�---- - !'�. -------- ------------ ...............! Contractor's. Name-- - • - ---------- ----- ------- ------ Phone----•- • ...---........---... Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court [:] Motel ❑ Other ❑ Number of living units: A__. Number of bedrooms 4__ Number of baths P-2--�il9--- Lot size ---_ _--__________________ Water Supply: Public system ❑ Community system ❑ Private eDepth to Water fable ------ _ ft Character of wail to a depth.,of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Oe-Hardpan ❑ Previous Application Made: ilf yes,date----------- ----- l No New Construction: Yes e No ❑ FHA/VA-Yes No ❑ TYPE OF INSTALLATION,AND SPECIFICATIONS: I&A (No(No selitic tank or cesspool permitted if public sewer is available within 200 feet.) N Septic ank: Distance from nearest well__3'�- __-__Distance from foundation----- Q__.-------Material.__ U--_Ce17.•__________-•____, No. of com artments_ �--------- -_--- - _Liquid depth-------� --- Ca aci ` .... Dispos Field: Distance from nearest well_.�<Q-`___Distance from foundation------/_'9......Distance to nearest lot lines. -- Number of lines.________-_rk____- -. _ Length of each line-------Z37_11------------_Width of trench._��.______-___--_--___-______ _-- Depth of filter material--------- "'----.Total length------J,- -------•----_---_- Type of filter material-_-_--S+__ ,- - Seeps a Pit: Distance to nearest well_-_--/.Q�f_-__Distance from oundation--__--1-Q.'.___Distance to nearest lot lineS.J___-__ �- Number of pits_-- _-� Lining material------ -,__ Size: Diameter__---.-a7-+-3___-----Depth---v ------------------- 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 -----------------------------•-------------------•---------- -----•------------------------------------- ---------------------------------------------------------------------•------------------------ ----------------------- I hereby certify that I have prepared 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)--------------- •--- ------ -- --- --------------- net/or Contractor) By:---------------- -- - -„'•------------------------------(Title)---•------------- --------..------------- ---- -------------- (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 4, ' APPLICATION ACCEPTED BY_.- Q-. 7 -------------------- DATE �O REVIEWEDBli'------------------------ ----------------------- ----------------------= --------------------- ------ :DATE---- . - BUILDING PERMIT ISSUED - --------------------- DATE--- Alterations and/or recommendations:--------------- -r......................... ---- ------' -•---------------- -- :--_ -------- --- - -------- - -.--. t ; a 1 ------------------------------------------- -- ---•- -- ------- L FINAL INSPECTION BY: - Date------- ` - r/ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Haxellon Ave. 1 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocl;ton,California Lodi, California Manteca,California Tracyr California E.N-9 2M 1-67 Vanguard Press I � E I