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�; OR p� FFA C USE 7 _ ,�t�c1"._t Permit No. _ 4 q APPLICATION FOR SANITATION PERMIT { I ----------------------------- (Complete in Duplicate) Date Issued __. This Permit Expires 1 Year From Date Issue L Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described,. This application is made in compliance with County Ordinance No. 549. ;*Vs6 ��--. --- �f4�_ ---------------------------------------------------------------------- JOB ADDRESS AND LOCATION..:.----"-"--------- -- 3 . Phone - Owner's Owner s Name.------ .--- - - ------- ----------------------------•--- ---------- - ---------------- Address--------------------------- I-xtsx•--� -------------------------------------------------•----------------•----•----------•------------•---- ----•-- Contractor's Name----------au ----- Phone---------------•--------••--------- i t Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail/r Court ❑ Motel ❑ Other ❑ 10 Number of living units: -- _-- Number of bedrooms- Number of baths size ----��-- x--`�Z® r---------------------•-- Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table - ft. {tt Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EKHardpan ❑ I Previous Application Made: (If yes;date-- :} No New Construction: Yes [T--No ❑ FHA/VA: Yes LJ" NQ El I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--- -- ------------------_ _ 1111, . --- --- Liquid deoh ----------------Ca acit No. of compartments-- ---- --- --------------- Size------------------------------- q a p P Y � t Dis osal Field: , Distance from nearest well.___. .Distance from foundation---M_.f7------Distance to nearest lot line-----7-t-:-. y�� Number of lines---------------f- ---------------Length of each line--------YO---------------Width of trench....---�---- ------------------ Type ----------------- T e of filter materialr�iP {, - or/ ePth of filter material-"___1f-- ------_Total length----------_-_�4---------------- --- ` ) Y P Seepage Pit: Distance to nearest well----------------------Distance from foundation----.-------------.Distance to nearest lot line-".-_--.-------._ ❑ Number of pits--- ------------------Lining material---------- '---- ---..Size: Diameter----------------- Depth----------------- --------------- lP Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------.-------_--_. ❑ Size: Diameter---- ------------------------------------Depth------------- -------- ---------------------Liquid Capacity----------------------------gals. Distance from nearest building - Privy: Distance from nearest well-------------------------------------------------- g-- - ------ -------- - ----------- ❑ Distance to nearest lot line.-------- --- ---------------------------------- Remrepairing eling and/or �descr-i�be� - ---- ---------- ------- ---- -- ----- ep�'-- ------ -------------------------- 7F----------------- ------------------ 6- ---------------64 �--- -- --- ✓T � y ----------------------------------------•------------------_-_---_-----__-•-----__---------------------_.--_---""__----- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -------------(Owner and/or Contractor) ` (Signed) - ------------ --•---- --------------------------- - {Title) ------------------------ �c (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 # r DATE-------�j, Jr. Fc� APPLICATION ACCEPTED BY--- =------------------- ------------------------ ----------------- REVIEWED BY------------------------------- --------------------------------------------- ------- -------- -- --------------------------- DATE-------- --------------------------------------------,---- - - BUILDING PERMIT ISSUED------------- ------- ----------------- DATE f Alterations and/or recommendations------- ----------- ---- ------ ---------------------------------------------------------------- ------------------------------------------- ------------------------ .. ------------------------- ---------------------------------- ------------------------- --------- ---- Date--- -- -------------- - -- ------------ . FINAL INSPECTION BY=---------- --- - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 160.1 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Steitklon,California Lodi,California Manteca,California Tracy,California