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FOR OFFICE USE: i ---- - -- -- --- ---- '— > SJ APPLICATION FOR SANITATION PERMIT Permit No. __ ___ _______ __ _ (Complete•in Duplicate) ------------ -------------- - -------•------ --------- Date Issued This Permit Expires 1 Year From Date 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. 0 1 c� � _ _ JOB ADDRESS�ANLOCAT N. .o E Q + '�l7----------------------------- -------- Phone_ -3Owners Nam _ j- - Contractor's Name--------- .__ __.___.._ Phone% Q7 �f ----- - - ---- --- -- �, I Installation will serve: Residence ❑ JApartment House ❑ Comrriercial ❑ Trailer Court Nt Motel ❑ Other ❑ Number of living units: -- ----- Number of bedrooms -------- Number of baths -------- Lot size _ - -- -._._- ---- -- -------------------------------• ! Water Supply: Public system ❑ -,Community system ❑ Private Depth to`Wster`Table 'Q ft „.,,,,;,,Character of sail to a depth`of_ileet Sand ❑,.,:,Gravel Sand.`,Loam'o Clay Loam El Clay Adobe❑ • Hardpan ❑ - r.:.;. . =r ,FHA . ,Previous Application Made:-,(If'yes;date,R} -- -- 1 Nd _ •^New Construction:-Yes�O -N /VA: Yes ❑ No TYPE OF -INSTALLATION�AND'SPECIFICATIONS::. '�- l No septic..tank or cess ool'ermitted�if `ublic sewer-is available within 200 fee},) ( .. P P Pt. f , k Septic Tank: ^-" rDistancefrom knearesf well-----------------Distance from foundation------------------..Material ------------------------------------------------ " - Ca acit �p5GL5- No. of compartments----- ------------Size--- Liquid depth`. Capacity Disposal Field: Distance from nearest well-----------------Distance from foundation_=__..::—____—:.Distance to nearest lot line----_-_._..-_-_- mber of lines _ ------Length of each line-- ----------Width of trench - ❑�`1Gl ST% Nu Type of filter material-------------------------Depth of filter material----------------_------Total length-------.----------------------------- ----- V :l Seepage Pit: Distance to nearest well.-of rip__...._Distance om f ndation_3.S______-- Distance to nearest IA`t-lir e._ - �. Number of pifscl.)------------Lining material_-- Size: Diameter- -$------- -_--Depth_-- .--�P______________________ # Ds : ie Cesspool: � Distance from nearest well ________________Distance from foundation---_.----------- ..Lining material �� •��[] f .�r}r��,,,�-•-.ri mra�teria�l.------------------------------------- I �..;.-�-� .r,r�w•• Dim _ ___.__. ---- -Depth--------------- ----------------- ----------- ---,_Liquid.. Capacify �-------_- __-- gals- . ,I Se: aeter: _ Privy: �...r. • Distance from nearest well...... .------------------------------------.....Distance from nearest building------------------------------------ . - ❑ Distance to nearest lot line - --------- ---------------------------- ----------------------- - O Remodaiing and/or repairing (describe):........- ._ _--- --------------------------------------- t -----------------------------------•- --------------- ---------------------------- ------------------------- ----- ----------------------------------------------------------------------------------- - -------------- 11 , - --- -------------- ------•-------- --------- ---------------------------------------------------------------------------------------------------- I hereby certify th a e prepared this plication and that the wor ill be done in accordance with San Joaquin County i ordinances, State law , and' les and_Cegulat' s of the Sa Joaquin L Health District. (Si ned -------- -= _�` ..... ---•-------- ------------ --------- ---------- (Owner and/ar'Confractor) I -- - Y• L�t- = - -----------------------(Tifle) (Plot•plan, sh wtng size of lot, location of system i relation to wells, buildings, etc., can be pla d on reverse side). t _ FOR DEPARTMENT USE ONLY �^ APPLICATIONkACCEPTED B v DATE ------- ------------- -- -- ------ -- - -- BY"------ ---- ------------- DATE ---------------------------------- REVIEWED l -------- ---- BUILDINGPERMIT ISSUED-------- -- ------------------------------- ----------------------------- -------------------------- - DATE-------- Alterations and/or recommendations-------------------- -- - - ------------- ------ ------- ------------------------ ----------------------------- ---------------------------------------- -. ------------------------ ----- -------------•--------------------- ------ •---------------------- --- ------ ----- ------------------ -----------------•--•�------------------------------- -- --------------------------------- -- --------- ---------------------- ---------------------------------- --------- i ------------------------------......-..............-------------. ----..-. E ------ ------------------ - ------------ ------------ t t -�% - ----------------------- -------------------------------- Date... ------/:7 ------------------------------ Date....------/:7 9 ------------- ---- ---------------- FINAL INSPECTION BY ...__ --------------- t S JOAQUIN LOCAL HEALTH DISTRICT 9 ,1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Slocklon,California Lodi, California Manteca,California Tracy,California ri E.H.9 2M 1-67 Vanguard Press