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FOR OFFICE USE: II APPLICATION FOR_ SANITATION PERMIT ....................... ............ •-•-•--•If-... - . ....-----•. -- (Complete-in Duplicate) Date Issued 5 ____....'��:._._ T_his Permit Expires 1 Year From Date Issued Application is hereby macielto the San Joaquin Local Health District for a permit to construct and install the work herein�ed- This application is made in 'compliance with County Ordinance No. 549. 1I, /1f JOB ADDRESS AND LOC�' TIONj2?�!- A- _ . .... ............. Phone.Owners Name_ .__-_. .__. Address 7 7 !- l�!.-- ._.. ... ---- ....._ K_- .......-- : ................. ......... 1 _.. Contractor's Name_._.__._._.-.!I_ ____.... ................ ._..._... Phone.__.,_._._._.._..._-•--•-•_---•--• .�I Installation will serve: Residence �Apartmen�-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _ Number o baths_Z--- Lot size --- ---------- -- -•- ......-- -•-•-•-•------_- •II: � Water Supply: Public system ❑ Community Sys ❑ Private Depth to Water Table ___..... ft Character of soil to a depth of 3 feet- Sand Z Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ I Previous Application Madel (If yes,dote____-_....:__..... ) No ❑ New Construction:z:Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION IjjIA� ND SPECIFICATIONS: (No septic tank or classpool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well............ ...Distance from foundation....................Material ------- ._....__._._..._ ........ ❑ No. of''compartments..._....... __....._....Size...................:............Liquid depth......... ......._.......Capacity----_----..---.__�-.- II Disposal ielci: Distance from nearest well,.PA�®r.._Distance from found _.ation__. A.._._.._.Distance to nearest lot line._-��_____.-.. Numbe of lines._...-_-._--f. _. Length of each line•...._. ._.__:� Width of trench.- -�__.........__.......... ��.-.... Type of filter material_.. c...............__Depth'of filter material -/.-`f.............Total length_...._ ..____....._......-._._.__._ i let l Seepage Pit: Distanc to nearest well_.__._................Distance from foundation....................Distance to nearesot line_..__.__._._....- ❑ Numbed of pits.....................Lining material................._-__Size: Diameter.............. ........Deptn_._...---.._................ ..... Cesspool: Distance from nearest well ________________Distance from foundation._....._-_-...._ _.Lining material.................................. ._.. ❑ Size: Diameter.. .. .............. ................Depth-._......;.................---_--••-•...._.-:.-.Liquid 'Capacity._..........................gals. II Privy: Distance from nearest well...............................:.................Distance from nearest building.__.........----------.............. c Distance to nearest lot line - ------------------------------..................----•----•----••-'-------.................. ._.... I1 __________________ _____________________________ Remodeling and/or repairing (describe :................ �• - ~; ..-•-•--•--._._.... - l ....... - - - I II I hereby certify that Phave prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws d rules and regulations of the San Joaquin Local Health District, (Signed)............... -- ..----- i�........... -•-•---.. .. ... _. . ...... ._..:.:._... • --•:--......._-•--•-_ __.-.•................-............;2 - end/or Contractor) ,� _-_{Title).. (Plot plan, showing size of loft, location of system in relati��+, ,ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY •il / APPLICATION ACCEPTED BY._-t�.._ • - •- -- - - DATE._. ._¢�r_..'.�.. -•f2 REVIEWED BY............--......t ...................... ......... ........................................................... DATE........................._:.............................. . BUILDINGPERMIT ISSUED..................................................................................................... DATE........................................_............................ Alterationsand/or recommendations:............................................... ..........._....................................................................................I.......... ............ - - ..................................................-..........................................................•-_..............................--•••-..-_...-•••----_... ........ I ..............................•-- -_---- -------- ----------- ..................................................-•--------._...-----•--•-- ... -...._... Ir ............................................. ........................ _........_.......--------..._....•._...._•._..._..._-_..._._..-.._..-•--•---•-... .....................-••--•---..........._....................... FINAL INSPECTION BY:fr .............. Date/,� .. ......................... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.hlaselton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Blackfan,California Lodi.California Manteca,California Tracyr California E.H.9 2M 1.67 Vanguard Press 1.