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` FOR OFFICE USE: f _-----------------------------------__------------- 3 -- ------------- APPLICATION FOR. SANITATION PER Permit No. --..V11 .� ---= --=-------- ------ - - ----- (Complete in Duplicate) ` '� `--- This Permit Ex ires 1 Year From Date Issued Date Issued __. � � - 2 2?--t 3o---o/ Applicatjon.is 'hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. T_kis„application is made in complianige with County Ordinance No. 549. , C �*,i �"T -t+ e -STF/NE6110 — ESC, JOB ADDRESS AND LOCATIWil. - alb! TJ _ �� lF -- ---. ---- Yah---------------------- - O _ Owner's Name-------- _--.------1l �� --------------------- ------ Phone------------------------------------ Address....... -------------------------•--__----Address------• -- ---------------=----------- =,: Contractor's Name `' iNE --------------- Phone...................................... Installation will-serve: Residence /Apartment House Commercial ❑ Motel ❑ Other'❑ LI �T ❑ ❑ Trailer Court � Number of living units: __ �___ Number of bedrooms'2-- Number of baths/----- Lot size __- _ ___ _�. � ` Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 35_ ft ' A Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Er Clay Loam ❑ Clay ❑ Adobe ❑ Hard6an Previous Application Made: [If yes date................... ] No Rj-"`New Construction: Yes ©ala ❑ FHA/VA: Yes ❑ , No [� TYPE=OF;INSTAL-LATIO N•AND-SPEC IFICATIONS:-�= - - - - ��.s..�.� - -- �� ► (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well----- ---Distance from founddation----r<Q_____- Material_`;;PN � T_—_F-:.......____. No. of compartments.-._2•:_------- ...Size._/TM __.� ___Liquid depth.... f� .......Capacity...L Q-Q-__- Disposal Field: Distance from nearest well----5._0----Distance from foundation___./©---------Distance to nearest lot line---_J_7_ Number of lines----- g _`-_�-Width of trench.. y Length of each line_..___ _. Type of filter material._R6 Gam_.-.Depth of filter material------I?.........Total length---------- __;a# . Seepage Pit:, Distance to nearest well.---10- --_____Distance-from foundation-----&I-------- Distance to nearest lot line___ ------ Number of Js.__ ____ ..Linin material__ __ Q_C-J<. Size: Diameter___. f ------- ----------- Cesspool: ` I �J P g Depth � - -------- Cesspool, '• Distance from nearest well ________________Distance from foundation----------------- _ Lining material----------------- ❑ » ,f ,}. ...Size: Diameter- - ------------ -------- Depth-------------- ------------ ----------------------Liquid Capacity----------------------------gals. Privy: - s. ' Distance from nearest well_________________________________________________Distance from nearest building---__-___--_..._._______-_--_._.__..._.._- ❑ Distance to nearest lot line --------------------- ----------- --------------------------------------------------------- Remodeling and/or repairing Idescribe):_...----MSr#944 ,r=�T __._ _ky____-_---I ---------- ------------------------- ------------- ---------- ----------------•-----------••--•--------------------------------:------------------------------------------------------------ -------------- -------- I hereby certify that I have piepared this application and that the work will be done in accordance with San Joaquin County ordinances State laws, and rules and re ulations of th an Joaquin Local Health District. (Signed} ` - - 'and/or Contractor) .. wne BY:------------------------------ • •---•--•-- -------------------- ---- ------------ - {Title) - (Plot plan, showing size of lot, location of system in relation to•wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -f_13-t_0.......................... - - DATE_ _� ... --------------- 1 REVIEWEDBY------------------------------------------------------------------- ------------- ------------ DATE BUILDINGPERMIT ISSUED-------- ----- ------------------- --------------------------•--------------- ------ DATE------------------------------------- Alterationsand/or recommendations------ ----------- --= ------------------ ----------------;-------- -------------------------------------- ------------•--------------------------------------- ----------- ---------------------------•----------------- ------- = ----------------------------------------------------------- ----•-------------- -------•---- ----- ----------- ------------------- ---__------------- -- -------- -- - ----- - ---- -- -- ------------------------------------------------------------------------- --------------------------- ----------- ----- --- -------.. ..... .-- ---- ---- ---- --------------------- -------------------------------------- -------------------------------------- - ------ i FINAL INSPEC N BY:.. / a�> F Date--- - --- --- --" 6-- -74 ---------------- ------------- 4 t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockton,California Lodi. California Y Manteca, California Tracy,California k E.H.9 2M 1-67 Vanguard Press r �` •- It