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FOR OFFICE USE: ------------------ Permit No. APPLICATION FOR' SANITATION PERMIT - ---------- -------------------- - -_------------ ---- (Complete in Duplicate) Date Issued _ - -. This Permit Expires 1 Year From Date Issue 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. r --------- , ---)--------------------- ------ JOB ADDRESS AND LOCATION._______ _..__ » /V /+ Phone Owner's Name--- --�.1� / ",`- ---------------- ---- -------------- --------- ------------------- Address--------- ------ -----,-------------- ---- --------••- -------- Contractor's Name--------------- �{ L✓- G 'l/- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -_- Number of bedrooms__ Number of baths/--- Lot size -— Number of living units: _ �- -- - � Water Supply: Public system ❑ Community system ❑ Private A�epth to Water Table-Q� ft Character of soil to a depth of 3 feet"- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe &?'oHardpan ❑ \ Previous Application Made: (If yes,date__------._..------- ) No 'New Construction: Yes ®/leo ❑ FHA/VA: Yes g�--sNo E] > F TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic .tank or cesspool permitted if public sewer is available within 200 feet.) �, Mat r' I. t`�� Septic Tank: Distance from•nearest well_,j�+7 -___Distance, �frr m+�found ton_. __ No. of compartments...----- Si___ _Liquid depih_ .- -- -.-Capacity- --- 1 - - �' _.__._..Distance to nearest lo`t line__ _______.___. 1 Disposal Field: Distance from nearest�well ------- Distance from foundation___ -- 9/' Number of lines--- ---Length of each line__/. - ---- Width of trench-��-_._�__.._______._____..-- 7 Type of filter materi�� --Depth of filter material..... --- _-Total length__ ----------------ti-�---- .� ______.Distan e to nearest lot line_-'�.______.__ Seepage Pit: Distance to nearest well-._i'� ----Distance from foundation-__ ___ ��## �®G� Size: Diameter_. ---------Depth ----------- ---- ®/� Number of pits__.a�------- -----Lining material._...--_.---- 4 . Cesspool: Distance from,n"earest well -------------_Distance from foundation----------------- -.Lining material------------------------------- al-- s. ❑ Size: Diameter- -- ---- ----.Depth------------ - --------------------------- ------- Liquid Capacity--------------------- -----g - -- ----- ----- .Distance from nearest building Privy: Distance from nearest well------ -------- --------------- g ------------------------- ❑ Distance to nearest lot line---------------- - ---------- - ----------- - --- ----------- --------------------------------- Remodeling and/or repairing {describe):------ -/��-a_ ------- -- •-------------•-------------------------- -------------- ----------------------- ..t. - — — 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, and rules and regulations of the'San Joaquin Local Health District. �r ------------ Contractor) (Signed)--------------------------------- By:------------------- ------- --------------By:--•---------------- ----- (Plot plan, showing size of lot, location of systn relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY Gs. ,.y, +r► DATE----- .---— ------- ---•------------------ I APPLICATION ACCEPTED BY________ __ ___ REVIEWED BY------------- ------------- ------------ - -- - - DATE DATE BUILDING PERMIT ISSUED-------- -- -----` ---- ----------^-------- -- ----------- -------------- ------------------ Alterations and/or recommendations:__--_. ----'-------- ------------ ------------------------------- --------------------------- ---•--- ------- - rt -------------- ---------------- tt // Date FINAL INSPECTION BY .. __. -� t�. ---•--------- ._--l-- `._�I2_ -------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 5lockton,California Lodi,California Manteca,California %Tracy,California E.H.9 21A 1.67 Vanguard Press