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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- -------- -- --- ------------------ _. .. - --------------------------------------------------------- (Complete in Duplicate) -� ---------------------------------- This Permit Expires 1 Year From Date Issued bate Issued ____ Application is hereby made to the San Joaquin Local Healfh District fora permit,to construct.and install the work herein described. This application is made in compliance with County Ordinance No. 549. } JOB ADDRESS AND ION /� �Q--�-4 - ----------------------- ----------- Owner's Name----a1� ._. Phone-------------- ---------- Address � ��-� f ( ` Y `- ----- .13 Contractor's Name---- -- ------------------- ---- - ----------- -- ---------- ---- --•--- Phone----------------------•- + Installation will serve: Residence ❑ +Apartment House ❑ Commecial ❑ Trailer Court [D Motel ❑ Other [; E Number of living units: °'�"_ Number of bedrooms _"'"Number of baths -A-_ Lot size ;i�ll fi�Q_--___________________________ Water Supply: Public system ❑ C'mmunify system E] Private [�epth to Water Table tt. Character of soil to a depth of 3 feet 1. Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ga- no ❑ FHA/VA- Yes ❑, No J9— TYPE OF INSTALLATION AND SPECIFICATIONS: � � (' (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' C= � k� Septic Tank: Distance from nearest well__ �.Distance m foundon____ __________Mateal_-! _ � -__._-.-____. No. of com artments-. Size_ _ Liquid depth____ `�.__ �rCapacity_ COY' p , ---2 , / #r T . _ r Field; Distance from nearest well_� 4e__pistance from foundation_��-_._.___..Distance to nearest I�t line_ ----- Disposal ry0�' Number of lines-___-_/_______ ____ ____ _ Length of each line-_1,0�__._�___-.Width of treneh.p4___.____ _!_i---------------- I t Type of filter material-1 Depth of filter material___ ._ -__..._..Total length... Seepage Pit: Distance to nearest well---------------- ---Distance from foundation--------------------Distance to nearest lot line.=______-__:___ 11 G ❑ Number of pits----------------------Lining material---------- Size: Diameter---------------------. Deptn---%:-------- �---------___.-- Cesspool: Distance from nearest well Distance from foundation___________________Lining material ... ................ A-1 Size: Diameter-_---.-------------------------------De th--------------- ------_Li uidCa acit I _------ als. Privy: Distance from nearest well --.________-.__----------------... ........-.Distance from nearest fa0&ng------------------------ _ ............... ❑ Distance to nearest lot line___________________________ ___ k If®�� jI Remodeling and/or repairing (describe):__, 44. _49��K ---}Y--------------------------------i--------------- --------------------------------- ------------------------------ ------------------------------------------------ ----------------------------------------------------------- ------------------------ ro 1 3s` 7 1 r =- 6 I hereby certify-that I have prepared this applica+ion and that the work will be done-imaccordance'with San-Joaquin County ordinances, State laws, and rules and regulations of the Sari Joaquin Local Health District. ' (Signed)!, i ned / 7:17,00067.4;7------------------------------ ------- --- - , Contractor. F ------------------- --------------== (Title) . .......... (Plot plan-, showing size of lot, location of system in relation t ells, buildingk, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---:_ DATE-------------------------- -------------- I+ f E REVIEWEDBY------------------------ ----- il-------------------------------------;------------ ---------------------- ------------- ----- DATE----- ------------------------------------------------- i BUILD.f:4G PERMIT ISSUED--!------ ------------------------------------- ' ------ DATE---------------------------- - ------------ ) Alt rations /or recom mendatib s: - j ---------- ------- - "! --------- 4ri --- 4. , - 2 47 FINAL INSPECTI BY:.. d.�i� DVAate � "- A ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellen Ave. i 300 West Oak Street s `%-4124 SycaMore Street 205 West 9th Street " 51ocklon,California Lodi, California Manteca,California Tracy,California •