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FOR FFIC SE: �-3 � � a ..--- �r�31 APPLICATION FOR SANITATION PERMIT Permit No. - 3 s --------------- (Complete in Duplicate) Date Issued � .. �3J --------- - ---------------------------------- -- ---- This Permit Ex ires 1 Year From Date Issue Appiication 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. � / 9400- JOB ADDRESS AN 0CAT10N. ---- ! 4 Owners Name Phone-------------------------rte. v - ----------------------------------------- �j _, , ------------------ Address ... --> / Contractor's Name---------- r ---- --------------- Phone----------------------------------- Installation will serve: . Residence Apartment House ❑9 Commercial E] Trailer Court ❑ Mofel [IOther El Number of living units: _. -- Number of bedrooms.?-... Number of baths -2--_ Lot size -/ ��---------------------------- Water Supply: Public system ❑ Community system ❑ . Private %r bepth to Water Table 1p, 'ft Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El'. Clay Loam lay E] Adobe E) Hardpan ❑ Previous Application Made: !If yes,date..........:.........) No 6pr' New Construction: Yes El 'No.PRO" FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public.sewer is available within 200 feet.) Septie"Tar�kY Distance from nearest well-----------------Distance from•foundation--------------------Material.....-.--...-.--.....-.-----------.-------------. No. of compartments------- ------------------Size------------------- ------------Liquid depth-------------- ----Capacity-------------------- f w / Disposal Field: ' ' Distance from nearest well./`Q._--_.Distance from foundafiion- - �---------Distance to nearest ]of line - ..._.-.-. �/r Number of lines--------- ---- ---- ------ -.--Length of each line-._ - ------------Width of trench.�..�.....-___.___---------•-- / H Type of filter materiai�y_ p `..--Depth of filter mater al.. _.�.-.-_Total length Type ------------------/--- Seepage Pit: Dis#ante to nearest welLdd�y�D.-�--....__Distance fr fo dation-da------ji tce to nearesfi lot I�e _/��j' ----Depth��_ ----- 9 / Number of pits----/--------------Lining material--- �"'---Size: Diameter ---- - . Cesspool: Distance from nearest well-----------'- _.Distance from foundation--------------------Lining material--.---. ................ ❑ Size: Diameter.- 1------------ ---------------- ---Depth--------------------------------- -° ------------ --Liquid Capacity-.-.------------------------gals. I ---...Distance from nearest building Privy: Distance from nearest well-------------------------------- ------ ❑ Distance to nearest lot line----------------- - ----- ---------------------------------------- Remodeling and/or repairing (describe)--------------OV/ ' ------------- - f - ------------------------ ---------- --- -------------------------•-------------------------------- ------- ------------- -----------------------=-------------------------------------------------------------------------------------- --- ----------------------------------------------------- I hereby certify that 1 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)ned �Y/� ✓ ----- (Qwaep °r Contractor) By:-------------- - ------------(Title) Gey i...... --------------------------------------- --- (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------` - --------------------------------------- DATE _- 3'-6. ' REVIEWEDBY------------------------------------- ------ --------------------------------------- --------------------------------- ----- DATE------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------- --------------------------- --------------------- DATE--.-- ------------------------------------------------------- Alterations and/or recommendations: /!tea / (:_ •-�_ ------------- -•----•--•----------------------------•----------------------------- - ----- ------------------------------= `s - ------------- ------------ - --------------------------------------- ----------------------------------------------------- ---------------------- -- ----------------- ------------- - -- ----- ---- i TION BY: � `-------- FINAL INSPEC �`4 � Date /.-.-. i ( I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Me. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stodrlon,California Lodi,California Manteca'California Tracy,California F.P.CO.