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FOR OFFICE USE: � � 9 ------------- APPLICATION FOR SANITATION PERMIT Permit No. _ f' ---- ----------- - ------------ -- I (Complete-in Duplicate) Date Issued t This Permit Ex ires 1 Yeai From Date Issued Application is hereby made to the San JoaquinLocal HelDstrict 544r a permit to construct and install the work herein describe . This application is made i rflnliance with County WA1,1 r �T �� �/rVCiCI -- �.� -- --yam"--------------------------------------------------------------------- JOB ADDRESS AND L9 -- --- --------- ---------------- - -- ---- ---------- -------- --------------------------- Phone-------------- -----•------•--•---- Owner.s Name-- .trr_Yhl_ �_ .!.! S :i -•--------------------•---- Address =----------------- ------•----------------------------------- Phone-----•----------------------------- Contractor's_Name------ --------------------------------------••---- Installation will serve: Residence $I Apartment House ❑ Commercial i❑ Trailer Court ❑ Motel [I Other Number of living units: __/._._ Number of bedrooms .-.. Number of'baths Lot size ------ ------ ----- Water Supply: Pub4ic system 5U Community system ❑ Private ❑ Depth to Water Table _--_- - ft Clay Loam ❑ Cl ❑ Adobe E] Hardpan E]Character of soil to a depth of 3`feet Sand ❑ Gravel ❑ Sandy Loam ® ay No New Construction: Yes F1 No E] FHA/VA: Yes ❑ No [IN Previous Application Made: lIf yes,date_----- --- -- 1 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_plo --..Distance from foundation-0----------- --.Mat?r'sal ..(�E�.�----------- ------ Size Liquid depth- ------ ---- .CapacitY--- _.-£ -Q< [�� No. of compartments.___A.....- W 4 t Disposal Field: Distance from nearest well- -__Dength of from each line_foundation.-_.___.-----____-W Distance of#trenchnearest lot line--- ---------------- ❑ Number of lines .------------------- -------- length____. W Type of filter material--------------------_---Depth of filter material----------------- -------------------------- tion ---_---_--_ -._ Seepage Pit: Distance to nearest well-�pN@Distance rom foundation.__ __ .lf---Distance to nearest lot line _.30-------- k Number of pits_-- ---------- -Lining material._-.�_IC---- Size: Diameter-�.1i'-k. -- .Depth_---1_f ---------- Cesssppool: Distance'from nearest well ----------------Distance from foundation_..------.--___ ..Lining material__._...___.__..____..___.._.___.____- r gals, Dept-- h------ ------------------------ ----------- -------Liquid Capacity----------------- ❑ Size: Diameter. - ----------- --- ------ - Distance from+nearest well------------------------ -----Distance from nearest building--------------------------------- -------- Privy: -------- - { Distance to nearest'of lire -.._____-x<`_--_ ---- t Remodeling and/or repairing' (describe):---- - - ---r--" = l i ---•------ ----------------------- --•---------- -4 . --. ------ ------------•------- - ------------ I ----------r -----i---------------- done I I hereby certify th t I ave prepared thisons olf the n and oaquirlhL calkHealltheDi trictn accordance with San Joaquin County ordinances, St a aw , ruI t t � --------------------------(Owner and/or Contractor (Signed)---- -- -- that ---- - --- •tl . ! t By:------------------- (Plot plan, showing size of lot, location of system in relation to wellss, etc., can be placed on reverse side).building . ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ DATE. -I �J . - ------------------ ------- - ------ DATE------------•-------•--------- - ---- REVIEWED BY-------------------------- ------- ---- ------------------------------------------------ BUILDING PERMIT ISSUED-------- -- ---------------------------- ----------------- --------- ---- DATE---------- ---------------------- ------- -------------- Alterations and/or recommendations:...-___ - �w -------------------- -- --------------------------------------- -------------------------------------- ------- -- ----- - -----------------------r----- -------- ----------------- - ----------------- FINAL INSPECTION B -51 t SAN'JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 309 Wast Oak Street 124 Sycamore Street 205 West 9th Street Lodi. California Manteca,California Tracy,California Stoekfon,California � rn- , �.H.9 2M 1-67 Vanguard Press