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FOR OFFICE USE: v -------- ----- ------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. a_Q_...Wj_ r (Complete in Duplicate) ' -------------------------------- ___ ___ ___ __ ________ This Permit Expires 1 Year From Date Iss°.( ued Date Issued . = _ i _ ___ _iF _ Application is-hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application s made n com ante+ with County Ordinance No. 549.. �� , JOB ADDRESS AND LOCA____! ' -�- - --------�t>-----------I6Q0 - �1'--,vim------ ---------- Owner's Name--------Ca RC �.. 1 k_ _p_N�------ ---S --------------------------------------- Phone------------------------------------ Address------------- ----"------------------------------ Address------------• T _` -":- 0{CK--------9U.6--l-------------- OAA.l:DA4-- ---------------------------------------- ------------------------------ Contractor's Name.Uf`11DN��6RONVI>-----COKS :----Cp---=----- -------- Phone----------------------------------- Installation will serve: Residence F'](IApartment House f] Commercial, ❑ Trailer--4;~r [Motel ❑ Other ❑ Number of living units: _Z____ Number of bedrooms __�' _ Number of baths 'G.-dot size -----_ -------------- 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: {1f yes,Ate------- ) No 'New Construction: Yes [E�< ❑ FHA/VA: Yes [?""No ❑ ,r .TYPEiO(F oseptic P taINSTALLA:fLONYANQ..SPE P ,CIFICATIONS: Se tic akDnk or cecesspool permitted if public sewer is available within 200 feet.) I ` p pe �_ arest well__ O-----Distan from f d _- _44//ation ___.__-__.. ate"rial---. No. of compartments------2— -- --------5izei/ ` x 144"X 46Li uid de th_-. Ca acitQ" _ p .._.. .. Disposal field: Distance from Weare f well.,_.�ir�___...Distance from foundation_�_�__..._.._.Distance to nearest lot line-_,5J __________ , Q Number of lines___ Length of each liner- ': _.'.$Width of trench_._._ __ -y--�-------- 4 Type of filter material_--,l C-k,-.__Depth of filter; length - --filter, -Total -------------------- ---l-��----------- Seepage Pit: Distance to nearest well .-._.--___-_-.-------Distance from foundation--------------------Distance to nearest lot line----------------- ElNumber of pits____ _________________Lining material------_.__.------------Size: Diameter.-..--.--_-.____.--__Depth---------------------. ._ Cesspool: Distance from nearest':well-----------------Distance from foundation----- ------------- Lining material---_-----.------------------.__.-----. ❑ Size: Diameter------ ---------------------- -- -----Depth----------------------------------------------------Liquid Capacity-.-.------------------------gal Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 17-1 Distance to nearest lot line----------------------------- --------------- --------------------"--•----•--------------------------•-------------------- ------------------- Remodeling and/or repairing (descriibe):-------------------------------------------------------------•---------------•---•----------------------------- ---------------------------- ------- ------------------------------------------------------- ----------------------------------------------------------------- - - ---------------------------------------- -------- ----------------------------------------- - ---------------------------------------------------------------:))------------------------------------------------------------------------------------------------------------------------------------------------------------ 11 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, and rules and regulations of the San Joaquin Local Health District. Jf F (Signed)--------------- ------ ------�---------_ ----- - --- -r--.---------- ----------------- ------------------------- -- (Owner and/or n or_ on r- ac r % , -----------Title �{ "- --._•.-9'.�� (Plot plan, showing size of lot, location' of system in relation to wells, buildings, etc., can be placed on reverse side). �f 1 f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- (_)3__V--------------------------- -- ---------------------------------------- DATE------ - '------------------ REVIEWEDBY------------------------------------ ------------------------------------------ ----------- -------------------- ------------ DATE------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE--------------------------- -- ----------- -:--------------- Alterations and/or recommendations:-1----------------` - -------- -_----------•--•----=---------------------------------------------------------------------------------------------- 1 -•--------------------- -------------------- -- ----- ------------- --- ----------------------------------------------------------------------------------------------------------------------------- ---------------- } ----------- I FINAL INSPECTION 1 - Date------------ _`. -'.� ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r California Lodi,California Manteca,California Trac Yr California - Y F.P.C Q.