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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .oz�4p2 . .. (Complete-in Duplicate) . This Permit Expires 1 Year From Date Issued Date Issued 0.----/�--� Application is hereby made to the San Joaquin Local Health District for e permit to construct and install the work herein described. This application is made in with County Ordinance No. 549. i 4 Z sa o � ..rte.,. .-. I JOB ADDRESS AND LOC TION.__..-/_ u-�v- - -__ __- -_- A t y Owner's Name V , Y ....---••-•---•••----- -............------------ ----------- . .... `•----------- Phone Address--- --------•--- l- ---••----------•-•-•••--•-----•------•--- Contractor's Name.....- -- r ._..--. Phone------ --------------_----------- Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: / _ Number of bedrooms � Number baths . Z.. Lot size ..... Water Supply: Public system ❑ Community system,[].. Private Depth " Water Table ...... - ft Character of soil to a depth of 3 feet•TSartd' Gravel ❑ Sandy Loam 9 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date ...-..._. ._-. 1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [] TYPE OF INSTALLATION AND,SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) } 1 I Septic Tank: Distance from nearest well.................Distance from foundation. I * I - Material .._ ❑ s No. of compartment ...-_i.-....-••--.- -: Size-------------------- -----------Liquid depth---.- _ -----. ....Capacity..- t . ...........•• Dispos Field: Distance from nearest well �.a-----Distance from foundation...,Gm-_........Distance to nearest lot line-.-�f__.�._.•.. Number of lines ......___../.._!... Length of each line_ -----W*'*.o................Width of trench.... :�.,.....__.._.:...... I ., o , Type of filter material-_.:: •{--Depth of filter material. ......./'...-.......Total length_--.._.,r's_----------------- ..--•- --_.- Seepage Pit: Distance to nearest well..................-_- Distance from foundation__-_______-_--_---- Distance to nearest lot line-................ ❑ Number of pits...l. ............Lining material---..._.. . Size: Diameter.......... -.. .. ....Depth.............:................... Cesspool: Distance from nearest well ................Distance from foundation................. ..Lining material... .... . ...!_..___........_._._. ❑ Size: Diameter. .. Depth...................................................Liquid Capacity I-•--• gals. ,ivy: . _ Distance from nearest well..................... f -----•......................Distance from nearest building.....................------............ :... ❑ Distance to nearest lot line r Remodeling and/or repairing (describe):-•---- t .- . . -..... - - ........................... •• - _-- -----••---- ---- ..............-..........._.............. -----•----•-•_.._ _...---.............-.................... ........... ......-................................-............ . . •--•-....•--•-•----•-••------••-•-•--•......._----••......-••---------. --• ------ 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. I (Signed)...---- ------- - -.... -•---- ---- ------- ------ .------------------------••--------f9x++ec and/or Contractor) —1= -- �— BY - ,.. - --- .....---•-. -........... .....(Tit e)---------------- ---.............. ._ � (Plot plan, showing size of lot, location of system in rely ;on to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._,,�Z_, -- -...-•---- -----------------------------•--------- DATE jl.-'YI_..'�,'7.._...---•---•-------•----- REVIEWEDBY----------------------------------------------- --..-.--.-..--•--•-----•--------------------•-•---•----..._.._-•------ DATE....--................................. BUILDINGPERMIT ISSUED-------- -- ----- •-------------------------------------------------------�-----:- .:•------------. DATE------ ................................. Alterations and/or recommendations:.. .................................;.-•---------..................-• .............. ...._..............-------- ............. .....__........:_..- .... -----•-•--•---•.......................•-----•----................ ---•------..._..-•---••---------..........-------.....__...........----••............--•- •....-•---•-----•..........._......------•-•.......... ...--••••- I - ..................................._..._........._:-----------.- . ------.._..._-._.......----•-.... .,. ...........................................................(.---•--.......__---..-...._..------..-•---- ..........------------- ----------•----....---- ------------•--• ------.................................... . , �. Date9 �FINAL INSPECTION � --•---. I y� 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ho:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon, California Lodi California Manteca, California Tracy,California E.H.92M 1-67 Vanguard Press i