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FOR OFFIC.� �SE.: --------------------------------------------------------- ----------------------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. . .... ---------------------------------- ----------------- (Complete in Duplicate) __..___..__ This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work here- described. This application is made in compliance with County Ordinance No. 549. /jOUIS& ��e �� 5 B JL JOB ADDRESS AND LOCATION------ 7-4-/-S7.-ZAP17 '-� -- -A-th-IjoP---------------! c: .------------- Owner's Name_ p ._1.LY-La.� s----------------------------------------------------------------------------------------_ Phone��4_a_.1-6 Address-------- ------- t r �/� �/ Contractor's Name. `� 1� 1if✓�+ Phone! E�_ '.' 7`I Installation will serve: Residence p rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ o� i Number of living units: -1------ Number of bedrooms __ Number of the _� S___ .� Lot size ---- ---f ---------------- Water Supply: Public system ❑ Community system Private UeDepth to r Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ 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. S Distance from nearest well_______________Distance from foundation--------------------Material.._____.._.._________.__________.__..._______. No. of compartments--------- fSize--------------------------------Liquid depth--------------------------Capacity-------------- R4J Distance from near st wel€_ �i __Distance from foundat' �__0_ ......Distance to nearest lot line_____-__ Number of Len th of each line___ g Width of trench'.cl'C Type of filter material C?.-�epth of filter material____.________________Total length_._.____..________________________________ Seepage Pit: Distance to nearest well---------------------- from foundation___________________ Distance to nearest lot line.____..________._ ❑ Number of pits----------------------Lining material----------------- - ---Size: Diameter-----------------------Depth------.-------------------------- Cesspool: Distance from nearest well--------- _Distance from foundation--------------------Lining material_. ---------------------.---------._- ❑ Size: Diameter--------------------------------------Dep'f h----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building_________________________-_---_-_____._.__ ❑ Distance to nearest lot line-------------------------------------------------------------------- -------------------------------------------------- -------- Remodeling and/or repairing (des cribe):----- ..- -- --- J- - --- -- - - ---- -- ----------- ___ . : - - :1_a' C= =_:__:___:::_::: ----------------------------------------------------------------------------------------------= ---------------------------- ----------------i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, dggrru�ules and regulations of the San Joaquin Local Health District. V11 (Signed)--- -- ---�L` '�#----------------------------------------------- -- - ----- --------------------------------------.. ._ ontracforj sE c -r NK SERV)g By29l5_E.-Miner-Auer.-=-f�?._E. ------------------------------------ (Title)-- _.-------- (Plot plan, showing size of lot, location of system in relation wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY-------_11R - �-'`n----------------- -- --- --------------------- ------------------ DATE------- [ � � " � ---------------- REVIEWED BY- ------------------------ ---- ----- -- ------ ------------ --. DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------- ----------------------------------------------------------------------------------- --------- DATE-------------------------------- ---------------------------- Alterations and/or recommendations-------------------------------- --------------------------------------------------------------------------•------------------------------------------------- --------------------------------------- ----------------------------------------- ----------- ------ -----------------------------------------------------------------------------------------------------------------I-- --------------------------------- -- ----- - -------- ---- -------- ------ n- -x1 1)----------- --- ---------------------------------------------------------------------------------I-------- FINAL INSP ION BY: Date-- /-I--"-- �J-�------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT r'1 `S5 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 0 0 Stocklan,California Lodi,California Manteca,California Tracy,California