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f FOR OFFICE USE: / — /T1 CyGKGa� E 3' Permit No. .7 ��p. APPLICATION FOR SANITATION PERMIT �►^�i ----- -........... (Complefe•in Duplicate) Date Issued 3 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, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LiOCATION..--------/... ._J�` -- .00 -T C.4la'do.. ------1,10G ...... Owner's Name----_----- :C,.............. ... ---------, ---------------- . ---------- •-------- --- . Phone..-�/4-�------------••---- Address 1.. .7 ,.1 _ ---- 5. - -g- ` ..... . _/�I-L.Q ••S. �Q 7.CA Contractor's Name-........3�!_,r.-r--1�.11�_!-'�s 0....._ O . ... '� = /. . ..:._. Phone.:. .7_.12.L7. �{7. Installation will serve: Residence 0 Apart4'tlent House Co;Vnercia rai er ourt ❑ Motel ❑ Other ❑ 41 Number of living units: .. ..-.- Number of bedrooms j_ Number of baths------ Lot size . . . �- l q �•-- - Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table ...-._ _ ft Q Character of soil to a depth of 3 feet- Sand ❑ Gravel D Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If 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.) l i, _ Material - -- 'Q.�Gn�' Septic Tank: Distance from nearest well._,:-.—Distance from �u��ation_._.`Q..._.. _. �� No. of compartments..._ ...____ i., _ .:Size__.--�L'__/- -._._--....Liquid depth_.._-. .._.._. Capacity.....�J`� -•9 Disposal Field: Distance from nearest well��-ZDistance from foundation ..._...-.....Distance to nearest {ot �ne./Q-..._.... Number of lines ---------- W___.-._.-Length of each line.. _. d.-...� ------ Width of trench...... �.-..-.-__.___. Type of filter materiai.� ,X4-Depth of filter material_._�0...._.... Total length___----/,Ze?--------------�.- �1! v S4�a it: Distance to nearest well-,9i0 _,...._._-Distance fro5p fo ndat'on_.463>9....... D fiance fo nearest lot iine01—47...... 1, Number of pits--- ; .-........Lining material..f�_._�aCSi�: Diameter. x/iL.....Depth_.--la.__--.•___-.-______ C1 Cesspool: Distance from nearest well ................Distance from foundation................. - Lining material------------------------------------- V Size: Diameter- - ----•-- ----- ---- ------ -Depth........................- ............... Liquid Capacity.._------------------•--__.gals. Privy: ......................................... from nearest building............................._------- QDistance to nearest lot line ................................................ ----_-- -----------------................... ............................-- Remodeling and/or.repair,ng (describe):.... ------- r------------------ ------- ------�,c.r//..------�J. •,' ..' �_ 1fJ -_. ,1`"�!/... /tip - .rl� }� of ---_...•.............•-------------------•---------------•--------- ............ ---------------_--•...--------- ------------- -...................----•..................... -------------- ................................... -------- •-----•--•--•-- ---•------- •------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count, ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ] Z-J -_--_-_-----_� .....-(Owner and/or Contractor) (Signed). C�/�-"�° . ��!'.1'�.'•'ie�� --•---.._... .yam aY� �1.c. �-�...... - .... - Ti+l }--- } �( e(Plot plan, showing size of l , of system in relation to wells, buildings, etc., can be placed o reverse side. OR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY._.G.,t/ - _..... - ......-•--------- ..................................- REVIEWED BY_-_-------------------- .................. DATE e `• . BUILDING PERMIT ISSUED -------- .......... -----•-- ...-------------- DATE......-.........----------- ------. ._........_..--- Alterations and/or recommendations:.............. .. ---••--................................................._..--- ..------------------.......... ..----•..................•--••----........_..._......_._...... _,_. •-----------....---......---------...-•-•--•-•... ................................................ ------- ---••........................... .................-•-............................................................................ .................................................•..................._........-•---•-- ....................... ln/ � FINAL INSPECTION BY:..._-1�.V- -_. --------- SAN ------ Date.. .. - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stackfon,Callfarnia Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press \({�