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r� itortv=r'Ik,.0 y3r., -------------- °�--------_..._.__.___.________ APPLICATION FOR SANITATION PERMIT Permit No. -------- (Complete in-Duplicate) �"''' ------------------------ '"""'"" This per I:x fres 9 Year From Date Issued Date Issued,.__ � 6 'f Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with Count OrdinN49. J! ; anc o. 108 ADDRESS AND L ATI N__1p� _- _ -• -- 's Name , ,� F ----------- ---------------- Owner ----- -------- Phone------------------<... Address-------- �.� - --------------------- -- Contractor's Name________________ ----------•--•------•---------- ---------------------------•---------•-----------------------................. Installation will serve: �Residence �. _ Phone ��Apa7.rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ WaterF,Number of living units. --/-.-.Number f"'� :Number of,bedrooms __Z_ Numt er of baths _/___ Lot size � X_145 -------- Supply. Public sys_ _ Co nityr sy_stem_.❑.:-_Rriv{to❑ Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel-❑ Sandy Loam [j Clay Loam❑ - Clay ❑ Adobe ardpan ❑ Previous Application Made: {if yes,dctte................:..:} No New Construction: 'Yes [3No [eFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:.. (No septic tank or cesspool.permitted�if public sewer is available with n 200 feet.] S tic a4: , r �.. ,. Distance from nearest well~ " "" -"Disfance from foundation s` , T T' ~� -- Material. ----------- ------------------- -------------------t No. of compartmentsSize-------I-----------------_L!Liquid depth_.__._--------------------Ca Capacity P tY ------------------- Di pospil Field: Distance from nearest well_. _.._---sDistancelfrom foundation____•"_.__ .... Distance to nearest lot line_________ ___ . �iTd Number of lines ----------=--------------- =Length of each line----+' -------------Width of french Type of filter material______________________ Depth oKfilfer m-a-terial_"Al.--.__--_-------Total length------------------------------------------- -------- --------------- Seepage Pit: Distance to nearest`welL "____ Di"1:6_nee-from-fo d,—ron______________�.--_.Dis nce to nearest lot Gne_.- ;lL�' Number of pits.-----4:------ -- �r Lining material--, ---- _____---Size: Diameter___'_ .___-__--..Depth__.-'r. f-•-•--- Cesspo ^Distance from nearest well__ ----------___Distance' from' -._.__:.Lining material-------------- - • ❑ Size: Diameter ------------------ ----------Depth.--------------------------------- Priv ' !.,� _ � -----------------Liquid Capacity_...------•------•----------9ais. y:' i,Distance from nearest well--- -----_ Dist from nearest building-------------------------------------- ---------------- ______________________ f , ` ---.---- -- Distance to nearest lot'line "'°r"�"—"i--'� ��•-t-"'•�- - . ----------- Remodeling and/or repairing (describe:-------------- -------------------- _____-_ ________:_ ____________________ _ r i ----------------------- ----------------•--------•----R-----•--------•------------ •----------------•--------4---------------•----------•-----------•-------•----•---•------•--------------------------------- _- 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,rd rules and reg lations,of the,San Joaquin Local Health District. 4 (Signed]= '�- '?�._ -•-- --------------- By:--------------------------------------------------....... Contractor) '�-- ---....-. (Plot plan, showing size of lot, location of �6 ' lationl o wells, buildings, etc.,.can 6e placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y__�__-- =--- ---- ------ DATE_._ REVIEWED BY ----------------------------------------•----------- DATE BUILDING PERMIT ISSUED----------- == ------------------------------------------- ---------•-•------------------------•----------------------- DATE Alterations and/or recomm ndatons_ __ _p 'Cr �– — f_Ia-__ ._...----- ----------------- ______________________________________ - ____________________________ ________________________________ ,1 FINAL:IINSPECTION -BY:__-= Date- �-L SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes!Oa_k st ee! 1245yeamore:Siraet Sfackton,California t ;4`\ `' �.` r;; 4 y 209 West 9th Street Lodi,CaliforniaCiiFManteca,Califbrnia� Yraey,California EB-9 REVISED e•69 F.P.DD.7M 6.6D