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FOR OFFICE USE: APPLICATION FQR SANITATION PERMIT Permit No. ._;._J._- ...... - ------------- ------------- ------ ----- --- ------------------- --------- -------- (Complefe•in Duplicate) Date d Issue � _"_.. .__...._..._--. ----------- ---- This Permit Expires 1 Year From Date Issued ..J_�,k-__--- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.,CA5. .._ 1D ---- .--- ------- -"---1 / -- 1 .._ Owner's Name.---- _. !-------- --------------------- ---------,----- -------------------------------------- Phone ."--f Z�"'►�---r r17 0 ------•1 L-"�...13,onX---•----- 7-=D--------- ' "`.. ------------------- ------------------------------------ Address. �! Contractor's Name------------------>�"-�A- -- �,-�---'��-- ----- ---- —�:1� - --------------------- -----------.-_-- Phone l0- 76 ... Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms 3... Number of baths_2-_ Lot size __ ._ - ' -------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table7ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,ddte_________---_----__ ) No)] New Construction: Yes E] No ] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: yy `` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-.531 - -------Distance from foundation--'_*------ .Material -�" . -- �/ h No. of compartments...------_......t Size. _!s_ _ ____Liquil!d depth.___ ......._ Capacity-/-Z+ 'r____'_ r Disposal Field: Distance from nearest well__. ____Distance from foundation-_i__ -----.-.Distance to nearest lot li ne--2, _� Number of lines_TIV .________Length of each line__ '�_ ti-.. Width of trench -. - _. ._ :------------------ ff Type of filter material,R-04K __ Depth of filter material----.1-. ..___-_.-Total length-----�--_____--n_--__--..__-___. Seepage Pit: Distance to nearest well__�.4rl.....Distance rom�tr foundation_ __.Distant to nearest lot Number of pits._- . Lining material.- - J ZX--. Size: Diameter_-_ . P ls- -_. - - - - - De to-- -- - ------ -- 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 ----------------------------------- ---------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----_ ._�.E __._._ < g. _...-. - -:5-tm .. A -- _ _ ------------ Y-CQ - -----------------:------------------------------------------------------------------ --------- -- ---------- -------------------------------------------------------------------------------- ------------------------ -----------I---------------------------------------------------I-- ------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,�aa rules and regulations of the San Joaquin Local Health District. N-_ 16 .. ... -- ----- ------ ------- �• --(Owner and/or Contractor) (Signed)----•---------- Piot plan, showing --a~o location of stem -- relation wells, buildings, 1 ._. �-----.---....--._.. . ( g y ngs, etc., can be place n reverse side). F D PARTMENT USE ONLY APPLICATION ACCEPTED BY._.-.__.__ ------ -------------- DATE___-_ -�lf:.._�j REVIEWEDBY-------------- - ------ ---- -- --- ----------------------------------------------------- DATE--.-- ------------- BUILDING PERMIT ISSUED---- -- - - --------- DATE------------------------ -------------------------- Alterationsand/or recommenda ons------------------ --__-- ------------------------------------ --------------------------------- --------------------------.._----•-------------•------------- -------------- -------- ------ --...-----------------------------------.-------------- ---------------------------------------------------- ............... ------- ----------------- FINAL INSPECTION BY: . ----------- Date"�..rld"_._.i� -------------------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockton,California Lodi. California Manteca, California Tracy,California E.H.9 2M 1-67 Vanguard Press t r '