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. 9G7. ......... _. ____ )%wOUCATION FOR SANITATION PEt..dT Permit ...... ......... - -- (Complete in Duplicate) Date Issued _. This Permit Expires 1 Year From Date Issued ..4....::. � 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.. F.JI-..LV..-Pz UL` ...J..:?. . 5 - ....... - ------ -- ---- �- Owner's Name.......�r_.js_.S�rC t27/7l I�� .J' " - Phone.. d 3--�ffl � Address.---------------✓� - !f .1fG! 57` 1 .:.--.-.... __..-.........-._.. Contractor's Name.-._. ..---------------------- ------'------ Phone.'77�G.-L,�. „r.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...- Number of bedrooms _7i 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 ....... ... I 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material__....-.......----------------- . ....... ❑ No. of compartments Size-------------------- -----------Liquid depth-------------_---._......Capacity----- ......._.----- Disposal Field: Distance from nearest wed.1�. 0.-... . well.. ._./.. -_. Distnce from foundation..._-A9......Distance to nearest lot line ........ XNumber of lines ...-._._ Length of each line--._---../� > ....Width of trench.....--..9.'/.....___.. LV Type of filter ' &f .--- --.._ ......._.-;.. --- _ --------------- See a e Pit: Distance to nearest well.. . �� ._Distance frofoundation...-4/9.. _Distance w to nearest lot line... Number of pits_. ..... .... ..Lining material_ .-Size: Diameter------ . Depth_._,_2-.,VL..----------_- Cesspool: Distance from nearest well -------.__....Distance from foundation_._............ ..Lining material__-.-------.-----.._----------- CN ❑ Size: Diameter- .. -------- ----- ---------------Depth- -------. _.....-...--------------------Liquid Capacity,_-------------------------gals. Privy: Distance from nearest well......_--- ._.___ _ _Distance from nearest building___---___------------- --__-----s ❑ Distance to nearest lot line. ... .- _..... _....-.-.._..----- .-- -''---------.--'-.-. -------------------- ___--- ---- ----- - Remodeling and/or repairing (describe):....._-. _ _.- - ... -•-. .-_./� /lel!firL!!Tl rf�' ---. 2 ._.... ............. ------------ _. -- ------ -------- -------------------------------- -- --------- -------------- - - --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ll}aws, and rules d regulations of +h San Jo quip Local Health District. (signed)------- ..K.-•-.s.--- `f-. ---- -- ------- ----`.. . . .... _..-> j� '---_-------------.-_.__-----.........._...(Owner and/or Contractor) By:------------- --_ - --- -------- ----- -----(Title)- ---- - ... ... .._..._ (Plot plan, showing siz of lot, I tion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-_.. --- --------- -------- - .. DATE----- - rl ..�o w-------------.... REVIEWEDBY...............---------------- ---------- . .. . . --------------- - ----- ---------------------------- . DATE.----------.......-------------------- ..----'--.-.._. BUILDINGPERMIT ISSUED......' -------------------- ---------------------------------------------------- -----------------. DATE--------------- ............ - -- - Alterations and/or recommendations:.------ ---- -- _......-- ...._.... . . . - ---..__ ..... -- .. ...._-... ...._._..-._ __ --------------------------------._---------------------- - - ------------------------------------- ----------------- ---------------------------- ---- ---- .. .. .. ... ------ ------- - -- -- -------------------- ---- ---------------------------------------------------------------- ------------------ ....... ------------------- - - -........._ _...................... _--- --------- ----------- ................ --------- --- ------ . --- ..... ._ --------------------------- ....... .. .. .......... -------- ..- ..- --------------------_ _- --------...-.._------------------------- - - -------- ---- -------------------- FINAL INSPECTION BY:----- . �� _ �.t�YL._. .... Date....... . .--. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haralton Avg. 300 We,l Oak Steel 124 Sycamore Street 205 Wast 9th Sfreaf Stocklon, California Lodi,California Manto,., California T,.,Y,California r.a.co.