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FOR OFFICE USE: y / 3� APPLICATION 1=C3 -SANITATION PERMIT Permit No. ._)•- - -------------.---------------------------- • ; ------ _- _ nµ (Complete in.Duplicate). - Date Issued3_-• _- ' `_��. I 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 --rf { .5.4 ATION___ ------•- --------- -------•- ------•-•----- � j^ l� -f JOB ADDRESS AND LOCs3--�. - ------ ph Owner's Name------ �--v ----- ______________________ ---- -------- --••------------------------ Address--` 15----.• -- _______.5__ _______________ _ Phone----------------------------------- Contractor's Name---- : - ---------------------------------------------- Installation - -{---------------------------------- Installation --- will serve: Residencgge of'- House [1,,.-Commercial Trailer Court [-IMotel ❑ Other [INumber of living units' __I_____ Number'of bedrooms4�__-_ Number of baths -1------ Lot size -- E�+ -`x--�� "- - 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 Hardpan ❑ Previous Application Made: (If yes,date ----------=--------) No New Construction: Yes Yr--No ❑ FHA/VA: Yes ❑ No [']� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within *, feed) IVZ Septic ank: °Distance from nearest well_=�_-------Distance from foundation_d--------------MatY riaL_-_---____t No. of compartments---_-�-----------------Size---- _ �4 �- -- q P ®pl _ _ Liquid de th -&-- ity.. . - ' f Disposal Field: Distance.from nearest well..__—'....Distance from foundatio _10-.:-----------Distance to nearest lot line _____.. Number of lines____ -----------------------------Length of each Ine___'_�d-�____---_.___.Width of trench.Z�_E Type of filter material'�jLS.�- __--____Depth of filter material_$-------------------- otal length: _ __�---------------------------- Seepage Pit: Distancetonearest well---- -----__------Distance om -f un Distance to nearest lot line_- P f o Number um Nbits---.-- ------Lining material-_ _- ._- _/ _ -Size: Diameter.-.12-----------Depfh____Z.J_7��-------------- j Cesspool bistance from nearest weC----------------Distance from foundation---.----------------Lining material----------------------------------- . Size: Diameter--------------------------------------Depth------------------C----------- ----------------- ----Liquid Capacity.-_ .------ ------------------gals. - �^ _ '_ -Distance from nearest building Privy: Distance from nearest.well ------------------------------ ----- g--:-----•-----------------•------ ----- .. i Distance to nearer/ lot line-------- ----------- ----- ------ ------------ --------------------------------•---------- f 3'+cif'' - /'w�.c,.✓.." . Remodeling and/or repairing (describe)-------------------------------------------------•-------------------------•-------------------- v ----- -----------------------------------=------ 9 ------------------------------------------------------------ ---------••-I-------------••---------•-----------------------------------••----------------------------- ------------------------ -- ---------- -- ---------------------------- ---•- -= ----- •--------------------------------------------------------------- - hereby certify that I have prepared this application Xnd that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regula+ionA/co +he n Joaquin Local Health District. ' _ ---------- -- ----- -------------(Owner and/or Contractor) (Signed) By:----------------- ----------------------------- ------(Title)------------------------------------------------ - ------ i (Plot plan, showing size of lot, lata ion o st - relation t wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �. ` APPLICATION ACCEPTED BY---- --- --------1------`�=��.---------- ----�------------ --------. DATE------ ------ - -----�-- •- •------------------------ IREVIEWED BY---------------------=----------------------- -------------------- ----------- ------- -----------:-------------------- - DATE BUILDING PERMIT ISSUED-_------------•------------ DATE Alterations and/or recomme dat' ns:___ __---- ---------- ------------:-------- -- - .. � � ° ' a .-- •--------- - ------- - --------- - �� ------------- -- ------------- -- ------------ _ -------- r'`'yt - kLt�e� -i ------------- - - .�A lfd �../�l 1 - ' � - y FINAL INSPECTION BY: ------- . �tt`- ---------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California ES 9'REViSEa 6-59 3M 3-'63 F-RCC.