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/K-)K 01-FIC:E USE: �D��'/e, - -------------------- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..... � ��Z.__-... ---- ------------------------------------------------ (Complete in Duplicate) d Date Issued --- -- This Permit Expires t Year From Date Issued 33 . 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 pNtiois mdeincom fiance ith County Ordinance No 549FF— 9 «�Y �� y Lam' �� A� L JOB ADDRESS AND WCATIOr2-=6r11 ---T ' Owner's Name---------- 0----------------------------------------- ----------------------------------------- Phone-437Z -74--•--- Address .-- `gel Co f .�- S -`--4-1-1 7-'7- Z-/ � Contractor's Name...------------------------ $ ----1- x"4e ��P + ---------------- Phon _ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _�-_ Number of bedrooms _ r r Number of baths _ Lot size --�c�ffJ---- --ls -------------------------- Water Supply: Public system ❑ Community system ❑ Private I( Depth to Water Table &_(? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 191 Hardpan ❑ Previous Application Made: (If yes,date--------------------) No)E!�— New Construction: Yes ❑ NoA - FHANA: Yes ❑ No 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-_____.-_______.-_.___.____-_______..___-______. 1 ❑EK'S4"A'6- No. of compartments-------------------- - ---Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well-________________Distance from foundation--------------------Distance to nearest lot line__________---____ ❑ 49-L5 4-Wb Number of lines-----------------------------------Length of each line------------------------------Width oftrench.---------------------------------- 4 Type of filter material-------------------------Depth of filter material----------------------- length___.____-__-_-___:__________________.___- Seepage Pit: Distance to nearest well----/��____Distance from foundation___ s__�____.Dis�ance to nearest lot line--- C9 Z Number of pits-&W- �___Linin material___ __.__.. _Size: Diameter_ _.__-_ Depth '7-�f------ ------ -.� I� P -- - - g --- �.3 � ---De to----- Cesspool: Distance from nearest well-----------------Distance from foundation___ ----------------Lining material-__.____._..____-______._-----_-____ ❑ Size: Diameter--------------------------- -----------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------._______,____-__-_--.________._. 1� ❑ Distance to nearest lot line---------- V ------------------------------------------------------------------------------------------ Remodeling and/or repairing [describe) - ------- --------------------•----------------- 1 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------•------------------------- ------------•----------------------------------------•----------------------------------------------------•-------------------------------- I hereby certify that I haverreed this application and that the work will be done in accordance with San Joaquin County ordinances, 5fate laws, and ruleegulations f the San Joaquin Local Health District. (Signed) ------------------ ------- ---` ----------,--_---- .(Owner and/or Contractor) By:------- -•---•---------------------- (Title)Ai .S-c T - ------- - - - - -------------- �Y[ - (Plot plan, showing size of lot, location of system in relation to wellf, buildings, etc., can be placed on everse side). FOR DEPARTMENT USE/ONLY APPLICATION ACCEPTED BY ------------- ---------- '" DATE REVIEWEDBY ---------- --=------------------------------------------------------- DATE---------------------- BUILDING - PERMIT ISSUED ---------. DATE ,. ------ ----- --- ---------- ------ Alterations and/or recommendafions:_____ �...___ _ ---L. : �._ _-._ - ------------------------------- i 4 --------------- -------------------------- }------------ - --------------•--------------- -----------------------•------------- ------------------------------------------------------------------------------------------------------------------------ ------------------------ -- -----•-•---------------- --------------------•--------•--------.._..--------- k ______________ -----------------------------------------------------------.._.___.___. ---.-- --__..______._._._______.___-___..__-.---------------------------------------.--------------._.__.__.__--_--___________ FINAL INSPECTION BY:. --- ---• - ------------- Date------ACP94�Z5 ��..--- SAN JOAQUIN LOCAL HEALTH DISTRICT J 601 E.Naieltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockloh,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8-54 3M 3•'63 F.P.CO.