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FOR OFFICE USE: ------------------ -- a APPLICATION FOR SANITATION PERMIT Permit No. -------------- ' (Complete in Duplicate) I { ..____.______ ------- This Permit Ex ires 1 Year From Date Issued a _ e 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. 549. JOB ADDRESS AN LOCATI -4�_ X_[ - ---------------------- -N -�=- -------•--- Owner's Nai F �n ------------------------------------------------------ P .a�t n,e� -...1. __ - ----- Addr ----- ------------------ l . -..------------------------------------- ------------- ------ -------------------•----... - Phone. ....Contractor's. Name---------=---------- --- ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ I Number of living units: ----I_ Number of bedrooms ---t Number of baths _ Lot size ---------- ..�,�t5________________________ 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 ❑ � 11. Previous Application Made: (If yes,dcite--- ----------------) No ❑ New Construction: Yes ❑ No ❑ F]1 iA/VA: Yes ❑ No ❑ TYPE;OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within-200 feet.) Septi ank: Distance from nearest well------�'�_7p_�_Distann from,foundation_---/'r-__---___Material-___..: _ ______________ 1 No. of compartments_._____________.__Size ` _______Liquid depth_________________ Capacity-/;�Oc__ _0A Dispos field: Distance from nearest well.__-------Distance from foundation___ -----------Distance to nearest lot line_��_--- Number of lines--------- ---------------------Length of each line------loo_..............Width of trach------x-----_______..__._.__.____ .N I r Type of filter material____,_d_1i-_____Depth of filter material-----._Af-W_____-Total length''"______ _ _a___`_____________ Seeps Pit: Distance to nearest .well 0.b_------Distance fro foundation__-.1.6-_-_-___-Distance.to nearest lot line---S__�_.._� � �. Number of pits------ Lining matSize: Diameter--------- Depth.... S_ ________________ Cesspool: Distance from nearest well-----------------Distance from foundation -------------------Lining material------------------------------------- acit ❑ � Size: Diameter------ - --- � ;k`;;; ---------.Depth---------------------- --------------------- __--_.Li quid Ca p Y-- ----------------------•--9als. Privy- Distance from nearest well___: ______________________._Distance from nearest building'�_-_-----_---_____________..__.._._... i ❑ Distance to nearest lot line.-- ----'--------=---------------------------- --------------------- -------------------------------"-----------------------------------.---- Remodel�g and/or repairing (describe)------------------ `4t------------------------------ ------------ -------•--------------------------------- ------------- --- {----- ------`-------------- ------------------- -------------------- -----------------------'-------------------------------------------------_-••-------------+----- -----------------•-------------------------------------------------------------------t---------------------------------- ----- �' r ! _ _ f ________ ____ ---______---------_______---_____________---______------------------__!t______------________.____________-__________--___-_-_-_._-________.____-__________._--_-_________________________________.___.___--.---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,-Stat411aw , nd rules and regulations of the San Joaquin Local Health District. _ dor Contractor(Signed) ------ ) Y=---- 90, 1 - =: {T ) �R(Plot plan, showing size of lot, location'-of system-in-relation to tells, buildings, etc., can be placed on reverse side). —FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -------------------------------------------------------- DATE-- --`r--G-- --------------------------------- REVIEWEDBY------------------------------------------- - ----------_---------------------------------------------------------------- DATE----- -----------'k----------------------------------,----- I BUILDING PERMIT ISSUED------------------------ y -------------------------------=-----=--------------------- DATE-------------- --- - Alterationsand/or recommendations---------------------- ---------------------- ------------------------•--------------------------------------------'-------------------•------------------- - ,------------------------------------------------------------- ------- -- ------ -------------------------------------------------------------- ------------------- 1_I I ----------- - ------ -------- -. ._.. r ` f -------------------------------------------------•---------------------- -- ---- --------------------------------------- ------- ---------------------- --------------------------- ----- --------------------------- ------- � �K----,---- -----------------------------------------------------.--_ _ --------- jr- ----------- FINAL - ---------------- -- FINAL INSPECTION BY: _ /!. � /� ...... ---------- SAN -- Date------------- - --- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street - Slocklon,California Lodi,California Manteca,California Tracy,California y E5 9 REVI6Eo 8•59 3m 3-'63 F.P.120. i -