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_ rvR llrrll.0 ux: ` ------------------- - ------------ ----- Permit No. ��_ ---------- ��"CATION FOR SANITATION PERK �, _------------ (Complete in Duplicate) Cl - -------------------------- This Permit Expires 1 Year-From Date Issue Application is hereby made to the San Joaquin Local Health District fora permit to construc an nista t or herein described. This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS A OC ION _ Oa-�?-�--- '`----�.......... Owner's Name -- -------- ----- [� - Phone ------------•----..._ Address ---- -------------------• --------------------------------------------- ----------- ----- - - ----- ---`--- - ---T-- 4 J I Contractor's Name --------- --- s Phone. '�� --- --- - ------•• --------- --------------- _ Installation will serve: Residence ❑ Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other I Number of living units: _"-'_ Number of bedrooms!=rr. Number f baths J--_ Lot size ------- ----------- ------ ------ - ----- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .----_-_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: tnk:o septic tank or cesspool permitted if public sewer is available within 200 feet.)Septi Distance from nearest well------ 4 Distance fro foundation----- 10_-----.Mate�ri�4--------- -------- ---___ �( - ��.tiquid depth-------- ----------------Ca Capacity Y-0 No. of compartments --____:.Size- P Y O - - P - r Dispos Field: Distance from nearest well..-. p- --�Distance from foundation-----/A------.--Distance to nearest lot line�--_..- __. Number of lines-----------/-------_ - ---Length of each line-------- 5;v ----------Width of trench.--- ------------------------- a Type of filter material-------- --- ----Depth of filter material-----11-----------Total length-_- S- i?-.-----__--.---------_`---. O - Distance to nearest well------�__0-0------Distance from foundation_-_1_----_�-_-_.Di+tante to nearest lot line----------------- �. _❑ Number of pits--------/-----------Lining material-_--- ----Size: Dtee�ec�/ /D---Depth- : ---_--------•--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------_----___------ u ❑ Size: Diameter---------------------- -----Depth-------------------------------------------------r--Liquid Capacity---------------------------gals. Privy: Distance from nearest well----------------------------------------------.--Distance from nearest building--------_--_-------_-----_--_----.-..---_. ❑ Distance to nearest lot line------ --------------------------- ------------ -----------------•---------- ---•---------------------------------------------------- Remodeling and/or repairing (describe)--------------------------------------------------------------- ------------------=---------------••---•-------------•-...---------•-•-------------------- ---------------------------------------------------------------•--------- --------------------------•------------ ----•---------------•---------------•------------------------------- hereby certify that I have prepared this application and that the work.w.ill be done in accordance with San Joaquin County ordinances, Stat s, and rules and reg ton ,of the San Joaquin Cocal Health District. -------1----------- --------------------------------- (Signed)---- --------------------- - ------------ -- - ----- ------------------. - _- w� an tract r d/or C..ori or{ ----- ------------ - ----- -- I. g --•----------- Title)----------------- -----------------]----- ------------------- I $Y� ` - - { 1 (Plot plan, showing size of lot, location of syste►I' in relatio to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY - -- -------- - ----------- DATE..' . "/, y�1a- REVIEWEDBY_.-------------------------------- ------- ----- -------------------- ------------------------------------------------ DATE------------------...------------- ------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------- ----------- Alterations and/or recommendations:..---•---- ------------- --------------------------------------------------------------------•--• ------------------.-.---------•----------------•----------- ------------------------------------------------------------------------------------------------------------- ------------------------------------------.-----------•------------ ---------- •------------------------------------------------ ----------------------------------- -----•--------------------------------- -----------------• ----------------.. ----------------------- FINAL INSPECTION y Date-------V ✓gl ---------------------------------------------- .�N SAN JOAQUIN LOCAL HEALTH DISTRICT °s• 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stoekfon,California Lodi,California Manteca,California Tracy,California