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R-- -FFICE USE: `` -J r---- - Permit NO- -----i APPLICATION FOR SANITATION PERMIT ------------------------------------------- ---- ---�� (Complete in Duplicate) Date Issued . ` ----------------- -- r,•LR-._-- - ` - ... This Permit Expires ices 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 Nr. 549- . � ---- JOB ADDRESS LO ION' ---- ----------='--------a-------------....... ------------------- ------ Phone--------=--------------------- Owner`s Name--m-,-- -- �K ------------------------------------------------- .. -----------------•-------•-------- ---- • - -------------------- - ---------- Address------- ---- Phone ------• Contractor's Nam _ ................• �. --------------=•---------- f Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ # -- Nu ber of baths Lot size __-- -- --------- Number of living units: ---f--- Number of bedrooms _ { -- """" ,4" Water Supply: Public system �ommunity system ❑ Priva e ❑ Depth to Water Table aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ,Clay Loam ❑ Clay ❑ Adobe 6--qardpan ❑ ' FHA/VA: Yes ❑ No Er -" __ -_ New Construction: Yes �'�N0 ❑ Previous Application Mader (If yes date ----------- � No . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank cesspoo pe it+e ublic sewer is available within.200 feet. -Q _.---.Material--�C�hC'� Septi nk: istance from neo st well--_ _ _----Distang from �undation_-"_----.-__"" l v �!No. of compartments-lz- ---------------Size--:33- - Liquid depth_ CapautY - P i _. .. Disp F' f Distance from near ell..W__' --Distance from ieiundation-- •_�-------_----Distance to nearest lot line_± _ .' ---------"---Len Length of each line-47 ---------------Width of trench_--__. -_� L--------------- Number of lines-- • 9 t, (a-� ->C-�.- -t_--De Depth of filter material- / Total length__c -•- � Type of filter maters __-" _ p t "� Seepage t: Distance to near II--- ._-.--"_.----- _Distance foundation_-1Q-_---_--_--.D• tante to nearest lot line__ Number of pits- - - :_ �-_--Lining nnaterial__4 .4"C__ Size: Diameter__:----_ 3_ Depth T� Cesspool: Distance_f,•om nearest well----_----_------Distance from foundation--------------------Lining material-_-------"---__--._.------ ------- i FlSize: Diameter--------------------- --- ---------Depth-------------------------------- --- -- _Liquid Capacity-. gals. Privy- Distance from nearest well-------------------------------------------------Distance from nearest building-__"---_-_._--____---------_-------------- il ❑ Distance to nearest lot line------------------------------------------ -------------------�----•--------........ - -------•-----------------------------=-"•--`----- --------•----------- ". Remodeling and/or repairing (describe):------------------------------------------- --- -•------------- ---- -- ----------- -- -----------------------•------------------------ ------ --------- - - :c S -oa ---- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ations f the San Joaquin Local Health District. -----(Owner,and/or Contract [O er a d/o or] (Signed)-------------------------------------------- (Title) - t --------------- ----- e BY (Plot plan, showing size of ca i n stem in r afion to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY ' - ._.� ---------------•-----------•----------- DATE------�------- ----------�--------- ---- APPLICATION ACCEPTED BY _._ ------- DATE---- ----"------------•-------------------------------- IREVIEWED BY-------------------------------------------------- -------- ------------------------------------------------------------------- --- DATE---------------- =-------------------------------------------------- ---------- - -- BUILDING PERMIT ISSUED----------------------------------------------_-- ----- -------------,------------------------- ----------- ------ - Alteratians and/or recommendat' n ' - ------------------------ ----- -- r - ;: ti :. ZIC -- G ,- - A� .r. st. ice•. - ---�--l�G{/-.-" -.--" n //� Date ----- --- FINAL INSPECTION BY:------ � : r - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasalton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California ! } Es 9 REVISED B-59 am 3-163 F.P.0 C.