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FOROFFICE USE: k 6 --.". ......... - ....__ APPLICATION FOR SANITATION PERMIT Permit No. � --------------- ----- ----------- ---------------------- (Complete-in Duplicate) --- ----t-- - -------- - ----------- ......... This Permit Expires 1 Year From Date Issued Date Issued ./"~---�_��o� Application is hereby made to the San Joaquin Local.Health District for a per. it-fo.-c�c�nstruct and install the work rein described. ? This application is made in compliance with County Ordinance No. 549. Zi�_iE:. 6 JOB ADDRESS AND LOCATION � --- YJ"ZV4,-_� .--- _Owner s - [!---------- ---- ------ - Address F... �.t / c PhoneC-! Contractor's Name------.--.".--- :-, __-• -- � ---- - �,� iJ - "-- " �-�'---- --.---- --------------------•--- ------- ---- ---- P hone_.--- tri � Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court E] Motel E] Other ❑ r Number of living units: _. ---- Number of bedrooms ..-__-- Number of baths-�? ot, size -_---- i` -------- ater Supply: Public system ❑ Community system ❑ Private Depth to Water Table la- ft f Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: {If yes,date--...- ---------- ) Nox New Construction: Yesx No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w Septic Tank: Distance from nearest well._,�.a-�-__ Distance from foundation--- --- ®-------,Material - _` i _ No. of compartments......�---._-_-- --- Size.- `� 9 Liquid depth-� Ca acit F .4,.. Disposal Field: Distance from nearest well" -P .___..Distance from foundation..., - ..d.__..-,_.Distance to nearest lot line:�...�1l�� Number of lines- ---- ---""---- ---------------Leng}h of each line-0 -- --- -------.Width of trench------------ Type of filter material_,57/ ------ Yp �° /�'----Depth of filter mat; rial _-__---...Total length-------------------- - _________ ___----Distance from foundation_...: Q f See Pit: Distance to nearest well"-__...__-""- ,.g 3.-....Distance to nearest lot line.......... ...... Number of pits--------------------.-Lining material ...---..".- :_ "S'izei,-Diameter.----------------- ---Dept ool: Distance from nearest well ................Distance from foundation "-- El ..Lining material-----S ze: Diameter. - - ------Depth-- ------- -----•------------------- -------------- ..Liquid Capacity gals. ,. Privy: Distance from nearest well. ......................'. - -----Distance from nearest building ❑ Distance to nearest lot line �-_ r Remodeling and/or repairing (descriue):--- ___ .(i1�P� ?1 ------------------------- 1 t* �-- --�J-'�----�1'(�[Q�tdi -------- - ------ ---------------------------------------- ------------- -- - i I hereby certify that I have prepared this applica+ion'and that the work will be done in accordance with San Joaquin County ordinances, State laws, and,rules regulations of +he San Joaquin Local Health District.I � (Signed)----- -- 1.[--c ' ------- �- ---<_ - - _( caner and/or Contractor] ------------------------- -- - - -- - e-- _ (Plot plan, showing size'of lot, location of system in relation to wells, buil gs, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y-__--- tl.-s.-___-, _ ---------------- ---- DATE EDBY ----'----- ------------ - --- - ----- - I------------ ------------ DATE BUILDING PERMIT ISSUED -- t i� ---- DATE----- -- --- r= Alterations nd/or re/co,,m_ mendations:.._....'_ t _ ` �� 7�4 h-YeC = --- G� f --- ----------------r -- -- --------- - -✓ . , -------------------- -�o.p -- ----------- FINAL INSPECTION BY:--- - - ( - ------- - --------------- Date------ � SAN JOAQUIN LOC HEALTH DISTRICT 1601 E.Hazelton Ave. 300 west Oak street 724 Sycamore Street 20.5 West 9th Street 5tvckton,California � Lodi. California Manteca, CaliforniaTracCalifornia ' y, aornia E.H,9 2M 1-67 Vanguard press Calif � ��,,,• i f