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OR OFFICE USE: 1 -`----- Q APPLICATION FOR SANITATION PERMIT Permit No. .��.>�-•.•�'.�. . ., s (Complete in Duplicate) /___� l `f Date Issued _._ " _.. ----------------------------- -------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San"Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AN CATION--=-----L�6 --------- l/u - t ---•—------------------=--r-----------------1 Owners Name------- ..----_.LAIR- --... --- - s Phoney Y„ { ----------- ............... Address---------------- - ----- - . •------ -------- - --- ----------- -- n Contractor's Name---------- - __.---•- _ Phone _._ �� t � a Installation will serve: Residence ❑ Apartment House ❑ Commercial Traileri Court ❑ Motel ❑ Other ❑ Number of living units: _f__- Number of bedrooms __/___ Number of baths --/,-?Lot srze ------; :_v_;._ ____.______ E Water Supply: Public system ❑ Community system ❑ Private Depth to Water TaRble.l _�ft.3+. , ❑ Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam E] ;lay Loam ❑. 'Clay #Adobe Hardpan ❑ [-] ❑ Previous Application Made: (If yes,date-----------------"--1 No ElNew Construction: Yes No [Q FHA/VA:'Yes E] No E] ' TYPE OF INSTALLATION AND SPECIFICATIONS: .; (No septic tank or cesspool permit+ed if public sewer is available within 200 feet.) Y i e ' ~ Septic Tank: Distance from nearest well---?�_.-_Distance from foundation__,l�__.--_..M�a/terial_._P,4_,�.!___ _____ �C 5� __�- -:---Liquid depth-_--- -- No. of compartments-------Cz----------`Size_ .":""=-__ f Disposal Field: Distance from nearest wells__--._Distance from foundation/Q--_:------Distance to nearest lot line___S_.._____ 6 I of lines-------- -------- -- Length of each line-----�.C?----=_------- ---Width of trench-----a_�/- ---- ------ --- Number ri + �'~"' T e of filter material epth of filter..material_---X8_-_---__--Total length_____"_____"_____-_._l�l�___"-___.___. - r . r � Q Seepa e Pit: Distance to'nearest well ---_-Distance om f ndation__.l0_ Distance to nearest lot line___-l� Number of ,pits--"""-:-- -Linin material _.--Size: Diameter-_3.— I- ------Depth---_rr _ -------------""-- '= l - g Cesspool: i Distance from nearest-well-----------------Distance from foundation---.---------_. _Lining material __.-----.____._--________---____;_ . Size: Diameter------ ----------+-------------------Depth-------------- ---------------- ---------------Liquid Capacity_.--------------------- -gals. I i --Distance.froma-nearest;buildin b Privy:. -�• - Distance from nearest well �-----------------`----------------------------- _ g--------------------_-------------------� � ❑ Distance to.nearest lot line--- - ---- S ------------------------ - -------- --------------------------_---------------------- 1 r I Remodeling and/or repairing (describe).-_�.__ ��w- �---------- -- -- -- -�-------- :--- •-------- ----------------------------- + �>�- -=-- = 1- - --- - ------------------------------------------------------•----------=--=---------------=------------------------------------------------------------------------------------------------ '.! hereby certify that I have prepared this application and that +he work' ill be done in accordance with San Joaquin County I ordinances'ST to laws, and rules and regulations of the San Joaquin Local Health District. (Signe d) # . wrier and/or Contractor) -------- ----- __W-------- --- �'of..sys' �� _-(Title)____ ______--- "_....__-..__-___"-.___._(Plot plan, showing sizeof lot, I'cationtem.in rela+ion +o a s, buildings, etc., can,be placed.on reverse side). - y FOR DEPARTMENT USE ONLY ' APPLICATIONACCEPTEDBY low- L� ------------- DATE--------/AA-5 --------------- T ------------------------ ` REVIEWED BY--•-----• -------- DATE---- - ---------------------------------------------- ---- � BUILDING PERMIT ISSUED---------- •--------- DATE Alterations and/or recommend)+ions:.------ t^ — �`�"`= "� `'�'_ - --- --- . ----•-------------- t ----- ------------------ F ! `2-` f ------ ------------------•-------------------------------------•--------•------------ ----------------------- -------------------------- ----- i------------------------------------------------------------- - ------- - ---------- - FINAL INSPECTION BY:. - =- --- Date AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 00 West Oak Street . 124 Sycamore Street 205 West 9th Street Stoddon;California Lodi,California Manteca,California Tracy,California I CS 9 REVISED B-99 3M 3-'S3 F.P.CC. 5„ 'J��