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FOR OFFICE USE: _ APPLICATION FOR ----------------- SANITATION PERMIT Permit No. l� ------------------ {Complete in Duplicate} This Permit Expires 1 Year From Date Issued � Data Issued --- ---------------- -------------- -- ------- _talh[ pp work� herein described, Application is hereby made to the San Joaquin Local Health District for a permit to construct and se This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION....__---__ --------- ------- 14 `"" ''a Owner's Name--- r.------ •- Phone ----------- - ---- - -- �-11------------ .�a'- ----------------------------------------------------------------------------------------------- f p Contractors Name------ -------- --------------- -- Ph�--��--fEl Number I Installation will serve: Residence � Apartment House [I ❑ ❑Commercial Trailer Court Motel Other Number of living units: _/.____ Number of bedrooms _,>'____ Number of baths 2--__ Lot size ----- ____a-cri��------------------- Water Supply: Public system ❑ lCommunity system ❑ Private [s- Depth to Water Table /071t. i Character of soil to a depth of'3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe RT Hardpan a Previous Application Made: ' (if yei,date---------------------) No [j—New Construction: Yes ❑ No Fj— 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 -----Distance from foundation_I-a____-_-____.Material___--_______ ____________ _______________. I # -_Ca Capacity !Z_�_a. ! No. of compartments..._-_�------------Size_SY A-S--<---- Liquid depth------'ir------------- p y-- r 1 Disposal Field: Distance from nearest well....r�_"_---Distance from foundation----/O-.____....Distance to nearest lot line_-__--______ dumber of lines--------3__________ ____ Length of each line__zP—q 0-�Lo--Width of trench-----Z----_____________-_------ Type of filter material-- - -_Depth of filter material-___!-Y-�'_-.----Total length S�_r_______________________ Seepage Pit: Distance to nearest well_./9_Q_.1_____Distance from f undation___;l Distancep__`-__--_. to nearest lot line-IS_ ----- -,7 ---_ �-� Number of pits-------�-__._____Lining materiaL__ _____Size: Diameter--,;rte______--------Dept h____-_-2.3-_-_--__-___.____-. Cesspool: Distance from,nearest well________________Distance from foundation-----------------...Lining material------------------------------------- ❑ Size. ter------ ------------------------------ Depth---------------------------------- ----------------Liquid Capacity- - ------------------------gals. Privy: Distance fromjnearest we _______________________________---_Distance from nearest building-____-_-________------_______-----_\ ❑ Distance to nearest lot line------ --------------- -- ------- ---------------------------- I----------------- ------------------------------------------------ ---------------------------------- Remodeling ------------------ ' Remodeling and/or repairing (describe)---------- ------- -••-------------------------------------------------- f t - --------------------- - - ---------------------------------------------------------------------- -------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San JoaquinCo ordinances, State laws, and rules and regulations of the`San Joaquin Local Health District. 1 G (Signed)--------- - P' r------------- ------------------------------------------- (Owner and/or Contractor) SY = ------ ----------- --------------------I-------------------------------------------------- ._Titl ------------ -------------------------- - -- ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6' placedon reverse side). I # FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY----. / - - -- -- - ---- ---- - --------------- - - - DATE---------- I ( REVIEWED BY------------ €------------------------------ ----------------------------------------------- DA -- •------------------------------------•----------------- i BUILDING PERMIT ISSUED----------------------- --= i - - ------ ----------- -- - ------------DDA/T E------------------------------------------------------------- 041� - Alterations and/or recommendations:------ --------•------------------------------------------------•----------- ------------- -------- ---------------------- = ------------------------------------------------------------------- ----------------- ---------•------------ -------------•---- -------------- --------------- -- ------------------ FINAL INSPECTION BY:...--,=_L,--- vd Date------- ---- -- ---------------------- ----------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ha:ellon Ave. #300 West Oak Street 124 Sycamore Street 205 West 9th Street s 5tocklan,California - Lodi, California, Manteca,California Tracy,California F.F.CC.