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FOR OFFICE USE: ---------------------------------------•--------- APPLICATION FOR SANITATION PERMIT Permit No. .- - �� ------------------------------------------ (Complete-in Duplicate) This Permit Expires 1 Year From Date Issued 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. L ff fj JOB ADDRESS N LOCATION.- �! .-r f2- _CJ_,q r/, _.... `� `T----__ � Owner's Name 11M �Q ----- ---- --------- Phone ,• � - Address -- •-- --- ------------- -- Contractor's Na - '.- - -- -- -------- --- Phon _1:7------------- Installation will serve: Residence (`Apartment H use ❑ Commercial ❑ Trailer Court otel ❑ Other ❑ Number of living units: _- /.- Number of bedrooms Number of baths I... Lot size P—��-Q __ Water Supply: Public system ❑ Community system ❑ Private�Depth to Water Table�ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&kiardpan ❑ 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.) Se ti `Tank: distance from nearest well-.�p-©.�-Distan from foun tionM ialry .--.-. 1.j P �-CIS-- -----------SizeC�R��?�Ln�Liquid depth-- `.?-. - - CapacitY--.f-�d•s7 No. of com artments_.Dis al Field: Distance from nearest well.-- ..-.Distance from foundation--f--�--�-..Distance to nearest lot line---8-_----__.. Number of lines- ._ ___-. -- ---Length of each line-+S_. -- .- Width of trench..�.0`'_,__-_ � T7' Tf f------- T e of filter materi �1 De th of filter material.. . -� g ,!,Q-�----- Yp P Total len th �y Seepa e Pit: Distance to neatest well--, ®-Q--_-Distance 9MfFundation__/---------------Distannce to nearestt lot line.-Cl-.---_.--Number of pits----�� __Lining material--.. Size: Diameter--_ ±-��.__-Depth- -�.-.r---..- ------------ Cesspool- Distance from nearest well ----------------Distanceundation------- _-____--..Lining material--___.-------------.----..----_.--.-- ❑ Size: Diameter t------------- ---------------Depth------------------------------------- --------------Liquid Capacity---------------------- ---gals. Privy: Distance from nearest well-------------------------------------.---------__Distance from nearest building.----------------_----------------------- { ❑ Distarce to nearest lot lire ------------------'<I" - - - ---------------•-------------------------------- ------------------------ -------- ------------------ Remodeling and/or repairing (clescri'be):...---- - - ---- •------------------- - .,--��`- ----- I --- -��.�- ------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------- --------------•---------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ` Iregulations of the San Joaquin L cal Health District. -..-- 5i nedces, -----e laws, an rules a��-- --.-- ----.�- �� -- -.-.- - r Contractor ( g ) g - J I By: ---------------------- ------- �t-i -- ------(Title(----------------- --- -- - ..---- --- (Plot plan, showing size of lot, location of system in relat to wells, buildings, et ., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED _ ---- ---------------- A �I7G7 ---------------------------- .- - - -- REVIEWEDBY------------------ ----------------------------------------------- ------ ---- - ----- -------------------------------- ----- DATE------------------------ BUILDING PERMIT ISSUED---------- ------------------ ------- --------------------------------- --------- DATE-------------------------- - J Alterations and/or recommendations:----------------------------_.---------- ------- ----------••------- .t ---------- ------------r............................. ------ ------------------------ ..---------- --- - ---------------- -•---- - I ------------------------ --...--...--------- --- ------ ----- --------------------------- ---------------------------------------------- --------- ....... ------ - ------------------------ --- ----- - - ------------------------------------------------ ----------- ------------------- -- ----- --- --------------------- ------------ FINAL INSPECTIONBY:------- - =- Date �_"�. -. 6 ... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street % Stackfon,California Led!. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press r I