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/ I V VI 1.1VL VOL: J 7 / // e .`3 ��q, r ------ -- A�ICATION FOR SANITATION PERM Permit No. ........ ------ --------- ----------- ------------ ------ (Complete-in Duplicate) ---__-_- . --..-.- This Permit Expires 1 Year From bate 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 .LO 4 7 A� 4 CATION. 1�4 t �y Owner's Name----•- ¢ '![.fit. j� Phone...-. �.2-- . .. ti � ' �! ------------ .. Addres3- �� 7`0 - ! ... -••--•. -------s ............................... Contract6r's. Name- . ..... ..... ... .... . .. Phone..--..-.._.................. ....... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E Number of living units: --'_-_ Number of bedrooms -4-- Number of baths..-- Lot size ----�'?"---- -------------------- Water Supply: Public system ❑ Community-system ❑ Private [Depth to Water Table _--.-- - ft Character-of soil to a depth-of 3 feet• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----------- ----- j No [ New Construction: Yes I' No ❑ FHA/VA: Yes No ❑ F ,� . TYPE OF INSTALLATIOIV.nAiJb SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) r F Seti �'� p c atik: Distance from nearest well---.S'd.�.....Distance from foundation__-_ld'."_.._..Mate`al.---_- __--- - -- ------------------------ - No. of compartments-.-_a2----------------Size _1� P-X-s_-Liquid depth---.-.�__.__- -------- Capacity-,1�.4?4 � Dispos Field: Distance from nearest well..4�Q-.......Distance from foundation.---_—/9`_-_.Distance to nearest lot lines----__--__-- Number of lines.....------oil-_._--nn- Length of each line-- ---- `...---- -_-__...Width of trench.._!4�.r------------------------- Type of filter material------- �.+ ._.t .--Depth of filter material---------Zf-~---..Total length..-.-1 5-- -------------------------------- Seeps Pit: Distance to nearest well------iA!P�'-___Distance from oundation--_-_--/e-0- -__..Distance to nearest lot line--S1 ; Number of pits---.-�----------Lining material----_- ,i Size: Diameter-------a9t-.�._...-._Depth__v�S ---------------- . Cesspool: Distance from nearest well - .._-._-_.-_-Distance from foundation----------------- --Lining material-------------------------------------- Privy: Distance from nearest well Size: Diameter_ -. -_------------- -- ----- -Depth----------------------------------------------------Liquid Capacity..------------..-.--: -...._gals. .---_.-----Distance from nearest building0 ❑ Distance to nearest lot line... --------••------------------------------------•------•---..... Remodelingand/or repairing (describe):------ ------------------------------------------------------------..------------------------------------------------------------------•------------------ ----------•------------------------------------------------------------••---------------------------------------------------------------------- ------------------------------------------------------------- ---•---------- ------------------------:--•-•----------------------••----•-----•-•-------••----------------------------------- -------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin'County f ordinances, State laws, and rules and regulations of the Sats Joaquin Local Health District. (Signed)------------------- -- ----------- - -----------' ----•------------------•-------------------------------.�[ ner-enc!/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). R.. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_--.. .--- -Q_---/ i�--. -( _-*--------------- --- ----- DATE-------4,----2-3:----�Q--�'-------------•-- - REVIEWEDBY.----•------------------------------------------------------------------° ----------------------------------------•-'-----: DATE---------------------------------- BUILDINGPERMIT ISSUED-------- ------------------------------------------------------------------------------------------- 6ATE------------------------------ Alterations and/or recommendation}s:_---------------'--- - ---------------------_-- ------ ----- ----------------------------------------------------------- ---------------------- ------------------•----•-------•-•------•--------•--•-•---- - - 0. !/ fes- �- FINAL_ INSPECTION BY:.----- -- !' -- --------------------- -------- --------- Date....... - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocklon,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press t