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T � ' f OR OFFICE USE: ---------- -- --- -------- ---- - - Permit No. __c�-�_G, -- �; APIA(CATION 1=0R SANITATION PERMIT ---------- ----- ----- -_._-_- ------ (Complete-in Duplicate) ,r ' Date Issued � I This Permit Ex ires 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'. County Ordinance No. 549. ��33 7 ,rte-- y - ---------------------- JOB ADDRESS AND LOCATION._ _ .- ---- Phone------------------------••- Owner s Name = ----"---••----•- I Address-----••----•------1-6--- •'r.-•--- _ � ----------------------------------------------- Phone---....._.-----------•-------•---... Contractor's Name--- - •------ - ---------•-------�---- ------- -------=-----•----- ---- ------- ---------- •---- -- -- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer amu4 � Motel ❑ Other ❑ ----- ------ ` Number of living units: l ----- Number of bedrooms ---27' Number of baths j-_._ Lot size ..._.�_. �`J _ i Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table '?.0- ft 1 Adobe Hardpan Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam-p Clay ❑ j Previous Application Made: (If yes,date__...--------__.._ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,.,.,��(No,.sep+ic tank-oricesspool permit+edrif+public sewer is available-within�200 fee+:}'�"�'� 0------- .Material -------------------- --------- -----• --� �� Septic Tank: Distance from nearest well-HCl._'-.__Distance from foundation-_1Capacity-` ---- No. of compartments-_- --------------'---Size_ _ _. - ''- ------Liquid depth--.-------. ------- Disposal Field: Distance from nearest wells---\---Distance from foundation._�_d._.-_--_.-.Distance to nearest lot line______________7r ------ -------------------Length of each line._.l(1�----------------Width of trench__�.y-`�---------------• Number of lines -----� Type of filter material/ ------of filter material___. l --"---.--dotal length___ ---------------- Seepage Pi{: Distance to nearest well. _ ___..___-Distance from foundation__ q 07 Distance to nearest lot lin�-17..__`�-___ Number of its_ -Linin material___ Size: Diameter--_.e? `----- ---Depth---A "--""--------'---- ru ing Cesspool: Distance from nearest well ---------------Distance from foundation.---------- Liquid Cateacit gals. ❑ Size: Diameter. ------ ----- ----- ----------Depth---:----------- -------- ---- --- ----------- q Capacity ------------ ------------- Privy: Distance from nearest wel!------------------ .-Distance from nearest building----------------------------------"- i ❑ Distance to nearest lot line-------------- - ------ ------------------------ Remodeling and/or repairing (describe):-- ----------------------- ----- -- ----------------------------------- "-- 1 --•----- ------------------------------------------------------------------------ --- -------------------------------------------------------- I ----------"--- -- ------------------ --------------------------i ---•------------ ------•---- ' ------------------------------- - 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 re ula ions of the San Joaquin local Health District. i -------- -(Owner and/or Contractor) (Signed)------- -------- --- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY-_. __--._ _ DATE----._-._� �.__ -.- ------ REVIEWED BY------ ---------------------•------------ --- -_-- ------------------------- ------------------------------ DATE-"---- -------------------------------------------------- BUILDING PERMIT ISSUED-------- -- -------------------- -------- DATE Alterations and/or recommendations:----------------- -- - 1 ------------ --------------------------------••-- ------ --------------------- ---------------------------- ----------------------------- --I ----------------- - -- ------------------- -------------- ----------------- FINAL INSPECTION BY:_ --------------- Date.... _( _/ -X— SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maiellon Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Lodi, California Manteca,California Tracy,California Sfockfortr California - E.K.9 2M 1-67 Vanguard Press ti