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rm FOR OFFICE USE , APPLICATION FOR SANITATION PERMIT Permit No. ...,lrfl ... _ (Complete in Duplicate) pate Issued __/ �.•--- This Permit Expires 1 Year From Date Issued . Application is hereby made to the San Joaquin Local,Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. U -< �AJOB ADQRE55 AND LOCATION... : �r�z_ �1' - ---•----:- -------- Phone-. ------------•-------------------- i Owner s Name-----------IL------ -------i-=----- - ' /5 - r %a.= --------------------------------------------- -------------•------------ --------------------- Address--- �`�... ' -- f- ---- - • - - ------- Contractor's Name_.-_ _ i j-,---"7 t Phone---------------•-----•----•---•---- ` Installation will serve: Residence �Apartmen# House ❑ •Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _mot size .!_ ""r? x--1 Number of living units: ___J___ Number of bedrooms __ -: Number of baths ______ Water Supply: Public system ❑ Commuriity system ❑ Private�x Depth to Water Table - -- ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam El Clay Loam El Clay ❑ Adobe❑ Hardpan El Previous Application Made: (if yes,Bate____________________} No New Construction: Yes No ❑ FHA/V},�: Yes . , No E] TYPE OF INSTALLATION AND SPECIFICATIONS: , .. (No septic +ank or cesspool permitted if public sewer is available within 200 feet.) :. F Tank: Distance from nearest well__ --.'5"'fi ------IaterfaL____ ` kSepti No. of compartments Ems------------Size t = - Liquid depth ��- Capauty_1-Z Disposal Field: Distance from near st well._, Distance from fours .ion J.?- �•sstance to nearest toy ne �____...- Len th of each lirf ~� R Width of trench .__.,�tr� ' ---------- Number of lines- �--------�-- ------; g ;�4-------- � e 'j : ! ----Total len th---------- 77 _ !'r ------------ Type of filter materiaL _rr_--�" --Depth of filter material___[- _______-- 9 /� y i nearest lot line_ oits---------=----=-------Lining material-_---f----------foundation- -Size: Diameter.---------------------. _---- __-•-Seepage Pit: Distance to nearest well________________ ____Distance from oun -___-._____.___-__.Distance to Depth ❑ Number f P Cesspool: Distance from nearest well................Distance from foundation_.__.-_.______._-_.Lining material----------------- als. Size: Diameter--------`---------------------------- Depth_----------------------------------------------------Liquid Capacity g ❑ - -_ ° _DistanE--from n'�`ea [5uildin9` ____ -- --- - +� 'Privy.' . .. _� Distance from.nearest well---- -- ----- .. ..r ❑ Distance to nearest lot line --------------------------------------------------------------------- -- - ------------------------- Remodeling and/or repairing (describe):------------------------------------------- ---------------------------------------------------•---------------------------------- O ----------------------------•------------------------ ---- --------------------------------------------------------- -------------------------------------------------- --------------------------- _ -- -- --------------------•----------:-.----------------- -. -------------------•-------------------- •--------------- ----- ---------------=---------------------- --------- ----------------------- i I hereby certify that I have prrepared this application and that the work will be done in accordance with San Joaquin Coun y F ordinances, Sate laws, and rules and regulations'of the San Joaquin Local Health District. _ ---------------------•-•--------------------(Owner and/or Contractor) ---------- U By:------ ----- ( / `)1 r -� (Title) - £ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE------------------------------------------------------------ --------------------------------- • � DATE--------- ----------------------------•--------------•-------- REVIEWEDBY----------- ---------------------------------------• ----------- ------------------------------------ BUILDING PERMIT ISSUED--------------------------- ------------------- Alterations and/or recommendations:------------------------- ----- ----------------------------------------------------- ----------------- --- -------------------------------------------- ------------ ----- ------------- ----- f -------- ----•---------------------------------- - _ ------------------------- -- r FINAL INSPECTION BY:.------- ---� --�•------ --------•---- --- ----- - ---- Date SAN JOAQUIN'LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5lockfon,California I Lodi,California Manteca,California Tracy,California I CS 9 mevI5EG 8-59 3M 3-'63 G.P.=