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FOROFFICE USE: ------------------------------------------------------- -------------- APPLICATION FOR SANITATION PERMIT Permit No.14 . a -------------- ------------------------------ (Complete in Duplicate) -------------------- This Permit Expires 1 Year From Date Issued 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. 1 i n JOB ADDRESS AND LOCATION_/#7--4 wZ 6Law- c r` cJ� �� ' .. Owner's Name__.a �.. � .....� -----------•---------------------- - - - ----------------------------------- - Phone------------------------------••---- ---------.1 �t�/ •- - ------------------------------------------------ Address Contractor's Name- - ----•-� � n' r -----------------A--- iI- --I---------------••---------------------. Phone----------------------•------ Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �'� Number of livin units: _f_____ Number of bedrooms 9 .3--- Number of baths --/--- Lot size ----V •---------------------------- Water Supply: Public system ❑ Community system ❑ Private Er_'Depfh to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe eql�'Hardpan ❑ Previous Application Made: (If yes,date------ -----------__) No ❑ New Construction: Yes ❑ No ❑ FHA/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 _-___Distance from foundafion___�_ __`.____ Material__________ ______ _______ _______________________ No. of compartments---------r-----------Size_T'G_!�d( fit'_✓r__Liquid depth---0�-'_-----------------Capacity._1P_ V__ .- r �• Dispas 'Field: Distance from nearest well--- --_,-_Distance from foundation-----I_G'.__r_____-Distance to nearest lot line-.S-'_r--------- Number of lines-------------- `2-.__ Length of each line___'_j_k_��--------------Width of trench._____Z_ � Type of filter material------- of filter material____1_f__"_,_____Total length____Z u___ _____________________ Seepa Pit: Distance to nearest well_____/_DEi r-----Distance from foundation___f �-----.Distance to nearest lot line__.__'------- 19 Number of pits----------_�.�------Lining matenal______��_,_Size:'Diameter--------�_'___-_ Depth----2—..5.i.______________.__ Cesspool: Distance from nearest well-----------------Distance from foundation....__.__..___---_ Lining material________________________________.__. ❑ Size: Diameter------------------------- - ---------Depth----------------------- }- -----------------------Liquid Capacity---------------------------.gals. t Privy: Distance from nearest well-------------------------------------------------Distance from nearesf building------------------------------- ---_.___._- ❑ Distance to nearest lot line.- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------ �� ------------------------------------I------------ -------------------------------------------------------------------------------•---------------------------------------------------•------------------------:---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I and rules and regulations of the San Joaquin Local Health District. (Signed)-------------- ---- -------- -------------- By: ----------------------- er and/or Contractor) f B ' --�;---- (Plot plan, showing size of lot, location o- system in relat' ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ - -!,<! f/--------- ------------------------- -------------- DATE---- REVIEWEDBY------------------------------------ -------------------------------------------------- -------------------------------------- DATE---------------------------- ------------------------------ Q IILDING PERMIT ISSUED---------------------- ----------------- ---------------------------------- DATE----- and/or recommendations:-------------------------------- -------------------------------------------------------•-----•------------------------•-------------------------------------- ---------------------------- - -----------------------------------------------------------------------------------------------------•- ---------------------•--------------- ----------------------------- ----------------------------•------------------ ---------------------------------- --------------------------- f----------- ------------------------ ---------------------- ------------------------------- ---------------------------------- -------------------------------- - ------------------------------- �1 --------------------- Date_/ '_Jb ---- ---------------------------- S JOAQUlN LOCAL HEALTH DISTRICT 300 West Oak Street ]24 Sycamore Street 205 West 9th Street Lode,California Manteca,California Tracy,California F.P.CC.