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VUK Url-IC,E USE: 9 ---------------------------- -------- ---- -------------------------�_----- ...._.--..___.-- APPLICATION ,FOR SANITATION PERMIT Permit No. ------------------ ` --`--- `------------ (Complete•in Duplicate) —,,, `� - ------------ ----- -------------- -- --- This Permit Ex ires 1 Year From Date Issued do Date Issued 2 _/-/-11:11 J Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 3 This application is made in compliance with County Ordinance No. 549: . I JOB ADDRESS AND-LOCATION_I-,- --------------------------- ------------------- ------------------------- Owner's Name____V ,,0,,,_.__- � �j +��--'�-�- +'�--------------------------------- ---------- ------ --------------------------------- a---------- -- Address- •-•---•af' ------------ Contractor's --• --- Contractor's • •-------- Phone----------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer CCt D?t -Z Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms _)�. Number of baths ----- Lot size _---- _- ------- Water Supply: "Public system ❑ Community system ❑ Private�0 Depth to Water Table77_94ft 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: t �(No septic tank or cesspool permitted if puublic�sewer.is available within 200 feet.) Septic Tank: Distance from nearest well.-r®'___ Distance from foundation----- !. 4!_ ._... Material __ ----------------_- No. of compartments---A--------------------Size--3. 14 ---X7--------Liquid depth----Y- ------- ----Ca acit Disposal Field: Distance from nearest welJa. --------Distance from foundation-If?.---...- Distance to nearest lot Number of lines.�__J�-_ __ --------Length of each ----------._-.Width of trench-.�-y---!------------------- Type of filter material _ _-_tel ---Depth of filter material_-. ' Total length-/ --------------- -------------- Seepage Pit: Distance to nearest well_--.-.!-----Distance from f undafion--11 ____--____ stance to nearest lot line__ --- [� Number of pits.-.(_.1_-___..._.__Lining materiaI__/Wit�_._. Size: Diameter--.�-3--' f � ' ---Depth- ', ------------------ Cesspool: Distance from nearest well _______________ Distance from foundation ------------- Lining material............ __-.....-_._.____.____ - ❑ Size: Diameter ----- ----- --------Depth Liquid Capacity gals. ; Privy: Distance from nearest we11______________ ------------------'-'-'---•- --Distance from nearest building---------------------------- El Distance to nearest lot line_-____________-------------- ------------------ ------------------ Remodeling and/or repairing (describe)-------------------- ------ -----------------------------------------------------------I--------- 1 -----••-----•-------••--••------------------------------------------------------•-------•------ ------------------------- 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, and rules-and regulations of the San Joaquin Local Health District. f"r____ _ . ,cam (Signed) ' -- - ------ --- ------------- _[Plot planY; - -------- --------------- - _(Owner rsiadned}./ or Contractor)� ---------------------- - ------------'------•--------- ----------------- - -' -- -- - - --- - -'-- -- --------------------------(Title)-------------- showingsze offo+, lo"catoofysstem inrelationfo Is' bdng�etccan b�e lPacedor_everseFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -i- -- DATE_,,a--- ----1 - - - --------------- ---------- VIEWED 8Y ' =----- ----------------------- ----- - -- -------------' ----- DATE BUILDING PERMIT ISSUED-------- -- - ---}------------ -- j -----'-'-- -------------------------'--- -...---------- ---------- DATE----------------- ----- - - ' A terafions and/or recommendations----------- ---- -' '- �- -' --- ---'- --- ----'----------------- ----------' -'-----•----- ------------•----•--------•----'--'----- --'--•---- --'----' ----------------------------- - ---------------- --------- '-' --------------- FINAL INSPECTION BY'__ ________ ____ __ -- • ----------- bate- .�. .� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 174 Sycamore Street • 205 West 9th Street Slocklon,California Lodi, California Manteca,California Tracy,California E.H.92N11-67 Vanguard Press