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FOR OFFICE USE: --------------- ® -- -- ------ -----------------------------------------_- APPLICAT}ON FOR—SANITATION PERMIT Permit No. . XII ------------------ -- ------•--------------------------- (Complete in Duplicate) Date issued _________ ------------------------ This Permit Expires 1 Year From Date Issued_ Application is hereby made to the San Joaquin Local Health Dlstri t fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION._____-3 --- ------------ t� ------------• ----- --•---•--------••----------------------------------------------------- Owner's Name - `wry) Phone `-7`. X',� 4 4 Address---------- - Contractors Name 1 -fir---------- � -------------- ----------------------------------------------- Phone.._V____4/._=-_l$_A Installation will serve: Residence PR- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ___ Number of baths __/_-_ Lot size ---------5-_p_-_54___�_�'�'_�_______________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan 1 A ❑ ❑ Y ❑ Y ❑ YD" ❑ ❑ Previous Application Made: (If yes,date____________________) No � New Construction: Yes ❑ No K--FHA/VA: Yes ❑ No F!!J� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation------------------- Material-------------______-____--______-------_-_--____. , No, of compartments------- ------ ----- -----Size-----••-------------------- ---Liquid depth--------------------------Capacity----------------------- isposal iefd: Distance from nearest well---Mo__"-_Distance from foundation____ -_--------Distance to nearest lot line-J-7- -_____ Number of lines----------1-------------___ _ Length of each line--------- __. ...... of trench.-_-_-2.__�-______-___________-_ ` Type of filter material-___.- ___Depth of filter material------1,V--____Total length___-__�c]-_r_________________________ (w, Seepage Pit: Distance to nearest well... Y[a------------Distance from foundation___Ym_-_`___._.Distance to nearest lot line_. ----------- ®l— Number of pits------/......-------Lining material_____- c6.<_A.Size: Diameter___, Dept h____._ZS`__f__-____--_-____ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining materiai__-_-___-_-__-_________-_-____--._.. Size: Diameter------- -Depth---------------------------------r------- Liquid Capacity----------------------------gals. Privy: Distance from nearest we -------------------- ------------------------Distance from nearest building------------------------------------------ Distance ___-_--_____---_____-_-- ____.____.____Distance to nearest lot line-- ---------- ---------- ----------------- ---------------------------------------------------------------------------------------------- Remodeling and/or repairing(describe)------------------------------------------------- -•--------------------------------- ----•-------------------------------------------------------- -------------------------------------•------------------------------------------------------------------------ ---------------------------------- •----------------------------- ---------------------------------------•-•-----------------------------------------------------------•-------------------------------------------------------------- ----- --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancest State laws, and rules and regulations of the.San Joaquin Local Health District. (Signed)---------- ! - {Owner and/or Contractor) BY:------------ " --- -----------------------------------------------------------------------------------------(Title)--------- ----------------- - ------- ------- - ---- -- (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 " APPLICATION ACCEPTED BY----- ---------------------------- ----------------------------- r. ��'DATE------- --r------- REVIEWEDBY-------------------------- ------ ------------------------------ -- --------- -•- - --- • ------------ ----- DATE---------------------------------------------------m-------- BUILDING ----------- •------- - BUILDING PERMIT ISSUED--,'---,,------------ ----- ----- ------------- DATE---------------------------------------------------•-------- Alterations and/or recommendations:___- .._Ur-.'C-____..__._...- G - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------m----------------------- t Date r/FINAL INSPECTION BY -_7- --------------------- SAN ----- SAN �J JOAQUIN LOCAL HEALTH DISTRICT 1601 E:Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street StecktonrCalifarnia Lodi,California Manteca,California Tracy, California F.P.Co.