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FOR OFFICE USE: ` ------------------------------ - APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) _jl -- ------------------ - Date Issued _------------------- 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. r JOB ADDRESS AND L CATI N. "�s �. -- .- -- --=t - -- - -- ----------- �- ----_ _ /�---- ----• . Owner's Name.._._Ld -a �! - - �---- - -M.1 Phone__. 1__=_�_Za Address...---- ---------------- - -- ---------------------------------------------- ---------- l .- ---------------------------------------- --------- - --- Contractor's Name ___ _. __ - ------ .0---- -- ---- ----------------------------------------------- Phone- ----- AW Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other--❑ Number of living units: I_ Number of bedrooms _ ." Number of baths.. Lot size _/- ----A.C" '------------- I Water Supply: Public system E] Community system Private,RO t Depth to Water Table/.01-ft i Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam.,❑ Clay ❑ AdobeA Hardpan ❑ Previous Application Made: (If yes,date-..----- } NoNew Construction: Yes'[] No FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: tJ (No septic tank or cesspool{permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well------------- Distance from foundation"-"----------------Material ----------_-----.-.__-__"_.---..-- -.__... { L ❑ 1�-` No. of compartments-___.._.. ------------Size-------------------- ---- -----Li uid de th--------- - - --- --------Capacity r Disposal Field: Distance from nearest well.-,1.5r___ Distance from foundation._190-I"___..Distance to nearest lob: line-AP f ' Number of lines.--45'14J&,-. Length of each line-- '._ f�---.Width of trench.------ - ----------------"- De th of filter material__.__" _. Total len th..."_ -- \' Type of filter material--� ---- p y 9 d `. Seepage Pit: Distance to neare st well-. _"Q "�._--Distance om fo ndation__ e .._._.Distance to nearest to Iine__��. __ . . Number of pits +�. �"._.__Lining material__��.- Size: Diameter._ 6 "-""."...Depth-..-� ------------ Cesspool: "_--..._.Cesspool: Distance from nearest well _--------------Distance from foundation ------------- -.Lining material--._...____---_-----.-------_._--__ ❑ Size: Diameter- - --------- ----- - --- -----Depth------------------ ------------------ -------------Liquid Capacity------------- --------------gals. Privy: Distance frominearest well_"_--....-_"....--------------------------------Distance from nearest building-------=----__._--".-..-__..____..__------ ❑ Distance to nearest lot line------ ------------------------------------------------------------ -------- ------------ - --------------------------------------:•-----R---------------- Remodeling and/or repairing des- ------------------ ---- ---- ~_ " -----•----------•-•-------------------------------------- --- . --- -- -- -------- - ..� - _ - -- --------------------- I hereby certify that I have prep ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules and regulations of the San Joaquin local Health District. (Signed)-------------- ----- , a1 - (Owner and/or Contractor) = t By:--------------- ------:--.--- ------ 4�'-�----- --- ----- ---- ---------=g---------- ----{Titley----- -- -1P- - }-........ - ---- -- ( (Plot plan, showing size of lot,.Iocation of system in rely ion to wells, buildin s, etc., can be lace on reverse side. I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --- �/ ��----------------------------------- -------------------- --------- - - DATE-- - --F-- -- -------- r BY------------------------------------------ ..... -------------- -------------------------------------- DATE - ---------- REVIEWED BUILDINGPERMIT ISSUED---------- -------------------------------------------- -------------------------------------- - DATE---------------------------- --------------- --------------- Alterationsand/or recommendations:---.-.--------------------......... ......."----------------------------------------------------------------------------- ----------------------------- --------------- -- - ------------------ ----------------------- I l --------------- -------- ---------------------------------------- -------------------------- --------- - - --------- I ----- ------------- - ----------------------- --•------------------------------- --- ----.--- -- -- .......... --------------------------- FINAL -- ------------FINAL INSPECTION BY:--------- `$ � 7 bate.... ---------- -------------- ----------- ---- -- - -------------------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 9tocktan,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press