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7 ------ APPLICATION FOR SANITATION PERMIT Permit No./. ----------------------------------------- --- ----------- (Complete in Duplicate) ---- 'I This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. _ ,l - 774 L-1 07 JOB ADDRESS AN C ON-- - • " �f� U l�//?---- i '� --` ------I-------------=-------------- �37 Owner's Name--------- ` -- - - - -----------------•-------_------------------------------------------------------------------ Phone---------- ---------------------- Address----------------••- 9 " Contractor's Name------- ------- �-------------------------------------------------- ----... --- Phone................................... will serve: Resides c'e:❑ Apartment House ❑ Commercial ❑ Trailer Othe Number of living units: _ _ Number of bedrooms __`._ Number of baths __f__ Lot size 40 /1_ Water Supply: Public system ❑ Community system ❑ Private ,Depth to Water Tabled It Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ge<ardpari ❑ Previous Application Made: (If yes,date---------.----------) No New Construction: Yes ®moo ❑ FHA/VA: Yes ❑ No ®f 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-44C9-----Distan e from m foundation-- _.___.Mate�---&A.. ..�� No, of com artments.. A-. Size_ P �� VLiquid depth ! Capacity- 4f i Disposal Field: Distance from nearest well.-4P.�_.__._Distance from foundation_,��.______.Distance to nearest lot line- Number of lines------/--__._ _._. Length of each line.__---------------Width of trench.-__--------------------------- Type __--------___.__._ __.-__Type of filter material_ . Depth of filter material-..__________________Total length___-00-r_______.____---_---_____: Seepage Pit: Distance to nearest well-_" _ ��, ,� /w �Q_._.._.Distance fr fo ndation____ _ ___ _____Distance to nearest lot lin`eJ_ _ ._._._ ®�• Dumber of pits....--/------------Lining material__ -.Size: Diameter U Depth lr� ter_-_A I 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------.-- ------------------------ ....... ❑ Distance to nearest lot line ---------------------------------------------- ----------------------------- 4$ Remodeling '�and/or repairing (describe)=------------�Gwo� L s------------------ ------------•--•---- `-------------------------- ------------ I, . .3...._,. .. a - . .- --------------------- -- ------------------------------------------------------------- ----------------------------------------------------- -------------------------------------------------------------------------------- ----------i------------ ---- I hereby certify that I hive prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d rules and regu! tions of the San Joaquin Local Health District. (Si ned 9 )-------------- ---- -- ---•--v----- - - ---�-;------ ---- ----------- --- ------------------------------------------- or Contractor By:_---••------------------------: ---------------------------------- ----- Title t`r1% j�- (Plot plan, showing size of lot,'location of system in re on to wells, buildings, etc., can be placed on reverse side). n . # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Ys__-.._. . ------------------------- REVIEWEDBY----- - ----------------------------- -----. .--- --___._----- ---------------------------------- ------ DATE----------------- ------------------------------------------ BUILDING PERMIT ISSUED---------------- Alterations and/or recommendations:____-- �� -- _ -------------------------------------------•-•--------- ---------- -------------------------- --- ------ ----------------------- FINAL INSPECTION BY:.--„ -- ...... Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT- ,. 4 �. 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street ; 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California r.a:co.