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FOR OFFICE USE: --------------------------------------------------------- .____.____.._._.______________________________________ APPLICATION FOR SANITATION PERMIT Permit No. 2._�.a� -------------------- ---------------------- (Complete in Duplicate) �77 Z411--1 Permit Expires 1 Year From Date Issued Date Issued . ___a`.�_-411--1 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. S49. 0163-- CGO--/7 T9q!3r —2 C_rv& OA-(r-- JOB � i� JOB ADDRESS'AND'LOCATION: `±-_�P-�c C�_- -------P-- --------------------- Owner's Namr -------------------------------- Address-A&_6 ---•---- --------- -- ------------- ----- ------------ Phone Address ! -------------- - - dt-�t.r -----------------•-------------••---- -- --------------- -- ----- a j __ Contractor's Name `-- ------ ----- ! Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/__ Number of bedrooms __3__ Number of baths 7�1_ot size Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table ________ ft. a.._ . � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan�r c Previous Application Made: {If yes,date_______,--------} No El New Construction: Yes E] No E] FHA/VA: Yes ❑ No, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) "! Septic ank: Distance from nearest well__5A'b"_..__Distance from foundation___L_Q_.......Material_.______ � No. of compartments_----__��----------5ize _ _ r s�_Li uid de th______1/.. ___ _Ca acit J�� r o Dispos field: Distance from nearest well._ '.__ Distance from foundation-----1-0__�__....Distance to nearest lot line_________.__ , Number of lines----------y____________-------Length of each line_____1__0.0......--------Width of french----Zt__/____------------------- Type of filter material____�__�_z........Depth of filter material-___1_�__"__-___Total length___�_C0----------------------------- ------------------ Seeps e Pit: Distance to nearest well._.__)-L)G_f_____Distance from foundation-----fp!-----.Distance to nearest lot line_.__._`_It Number of pits----___----------Lining material---- '. .. . Size: Diameter.__-_)__�!_"-_ Depth---2._ ._'__--_--- Cesspool: Distance from nearest well---------- -__-Distance from foundation_-------------------Lining material__.----------------------._______---_. ❑ Size: Diameter---------- ----------------Depth--------- --------------------------------- --------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well----------------------------------_--------------Distance from nearest building---._.------------------------- ---- __- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------- --- ----------- Remodeling and/or repairing (describe): 1= -------------- ----- ----------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------•----------------------------------------------------- -------------------------------------------------- ------------------------------------------------------------r---•-------------------------------------------------•------------•-------------------------------------------------------------------- ---------- --- ----------------------------------- -- ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- ------------------------- lyd/or Contractor - ------- ------------------------------------------------------ --------------- ------------------ By: A ----------;t�'------------------------------------------------------(Title) . ........---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR.DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY---. DATE_ - 3� ------------------------ --------------------------------- --- REVIEWEDBY------------- ------------------------------- --------- ---------------------------------------- ----------------------------- DATE------------------------------- BUILDING PERMIT ISSUED-------------- •-------------------------------------------------------------------------------------- DATE Alterations and/or recommendations----------- --- -- - -------------------------------------------------------------------------------------------------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------- ---------------------------- FINAL INSPECTION BY: -21 �`--------------- Date. ---- ------ ------ ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slocklan,California Lodi,California Manteca,California Tracy,California F.P.CO.