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FOR OFFICE USE: 7 -- Permit No. ------------ ------ --------------- APPLICATION FOR SANITATION PERMIT f (Complete in Duplicate) Date Issued �� �- ---- ----------- ---------------------- --- - � . This Permit Ex ices 1 Year Froth Date Issued K _ - -- d. Application is hereby made to the San Joaquin local Heal+h District for a permit to construct and install the work herein describe This ap lication is made in compliance-with County Ordinance No. 549. r � � -------------- JOB ADDRESS AN LOCATI'ON______ ------- � Owner's Name--- d !�l�c � - �! 'c = ---- Phone-_,..------------------------------ ------- � ------------- ----------- ----- ----- Ad d ress-----... C ;�- Phone.----- ----- "i _ - -- ._-•---------------••----------Z16) - Contractor's Name__. -� - � x Trailer Court ❑ Motel [Iinstallation will serve: Resident e 11 Apartment House'[] Commercial Other C1`h Number of living units: `;_ Number of b L- Number of baths :__—Lot'size edrooms _ 7 Water Supply: Publicasystem ❑ Community system E] Private 4 Depth to Water Table��lf ft' Adobe� Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam [jC y ❑ " j Previous Application Made: 11f yes,date--__---------------) No� New Construction: Yes [ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) } i r- � - ------------ Septic Tank: Distance from nearest well__-&-�L_-----Distance jro f unda�ioti------��-------,Mat rill __ —---- Size ��`.-- _Liquid depth - _. - (' ----Capacity-� v- No. of compartments__---`7 —1 Disposal Field: Distance from'nearest well...7 -_____Distance from foundation___ --__--Distance r_1 jr to nearest lot line___.5________- Number of lines,5_________---------------------Length of each lin6:,7 -`1x"j?'- j Width of trench__A_�4..------------ Type of filter Depth of filter material---_ e!1-----------Total length------F/--- ------ S ter materials_rAe— � Ilrest well ---------------------Distance to nearest lot line----------------- Seepage _.-____-____---_Seep ge Pi}: Distance to nea _______________..<--Dstanceroameter-----------------------Depth_____.--_______-____--____. Number df pits----------------------Lining material---------- - ------..Size: Di El III Cesspool: Distance from.nearest well__-__._______._(Distance from foundation---_----------------Lining material__--...___-__--_______-_---------- .-. Size: Diameter-------------------------------------Depth----------------- Liquid Capacity __ gals. ❑ :- =: Distance fro'earest buildi ------------------------------------- 'T ----- ------------------ �.. . _P_rivy: ��..- -_Distance 'From-nearest-well-_ _..:__J--=------- � ❑ Distance .to nearest lot ine----:____________________ ------ ---------------------------------- ------------------------------------------------------- i.il r a 3 ____________________________________ ---------------------- (describe): _____________________ Remodeling and/or repairing (describe): 1 ---- ------------- ------------------------- -'---------------------------- ti z- - = ----------------------------------------------•- ------------------------------•------------�,;------- ------------------------------------------------------------------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 41 ordinances, S I to la-�w-s--,----n--d----=u•-l-e--s-�I-a-n-�d--re„gulatio=ns-of the San Joaquin Local Health District. ` " (Owner and/or Con- ract or /(signd ---- ---- -- ---------- --------- ll �+ t ------------------(Title) --------------------------------------- i buildings, etc., can be placed an reverse side). [Plot plan showing size of lot, location of system in relation to wells, I� FOR DEPARTMENT1.USE ONLY APPLICATION ACCEPTED'BY. - --- DATE-•--------------------------------------------------------- I REVIEWED BY----------------------1-------------------------------------------- `------------ DATE fr' BUILDING PERMIT 1SSUEDI--------------------------------------------- ----- - -------------------------- DATE-- ------------ ----- - ------- -- Alterations and/or recommendations:-_____......:................ it ; ------ ------------ --•--------------------------- ----------- - ------•- .. --------------- r----- ------- II -•----------------------- ----------------------•---- ------ -------- w - j - - D -------------------------------- FINAL INSPECTION BY - ------------------------------- ------------------ ---------- ate------- ---------- ---------•�--=----- ---- ,I SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haselion Ave I1 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1, Manteca,California Tracy,California Stockton,California II Lodi,California E6 9 REVISED 9.59 3M 3--63I7F.P.0O. _