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i-UK Ui-VICE USE: - �� y. # -------------- -------------------------------------- i'APPLICATION FOR SANITATION PERMIT Permit No. .- ,3_ t ------------- ------------------------------------------ (Complete in Duplicate) = This Permit Expires 1 Year From Date Issued Date Issued .._ /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. 549. MD 00, Z=111111a JOB ADDRESS AND LOCATIO -�_ _ -_---- a3 � ___ r.. -A r ci_ h ._------- - .. -- ----------------------------------------------------- Owner's Name------ �_E 6 . ` 'H _ - Phone7j __.3_ I ,f. - Address------- ------------••---•-------------------------•-----•------------------------------------- Contractor's will serve NTE3CA------s iG---- Installation Residence 4?--Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _/___ Number of bedrooms _ Number of baths/ Lot size __�f�®-_- ,••l Water Supply: Public system E] Community system ❑ Private Depth to Water Table _8__ ft. Character of soll to a depth of 3 feet: Sand [3 Gravel ❑ , Sandy Loam @!�'Clay Loam [j Clay ❑ Adobe❑ Hardpan (] Previous Application Made: (If yes,date--------------------) No New Construction: Yes ENo ❑ FHA/VA: Yes ❑ No n' �- TYPE-OF INSTALLATION�ANDSPECIFICATIONS (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well---%O_-----Distance from foundetion---�E4___..___.Mat rial____4ne, T..l ........... No, of compartments �___-_-.._Size__ Liquid depth____'r .____----Capacity../10.0_0 Disposal.Field: Distance from nearest well----50---_Distance from foundation_-_ 1 <�-�.._____..Distance to nearest lot Number of lines______ ________________________Length of each line________ M' ' Width of trench. .. ............. Type of filter materlaE)--- C#t---Depth of filter material-__-,l ________..._Total length.............. —-------------- Seepage _---------_-Seepage Pit: Distance to nearest well----------------------Distance 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----- --------------------------------Depth----------------•--------------- ------Liquid Capacity gals, - ---- ---------•---•- Privy: Distance from nearest well-----------------------------------.-------------Distance from❑ nearest buildi11 1� g-------------------------------•---•---- l Distance to nearest lot fine11 -------------------------------•---------------------------.---- --- Remodeling and/or repairing (describe)________________________ ---------•------••----•-------•---------------------•-----•- ;----.. ------- 1 .._._ ---------•-------••--------.---•--•---------••----•-. -------•---------•--•------------•-----------------• -------•-----------------•--------------•-•---•---•------••-----•----•----•----•-•- ------------ -----------------------------------••----------------------------------------------------------------------•-----------`---------•---------•------------•-----`•--------------------------- , I hers, is e c�jfy t at I have prep' is ordinances, fap�plication and that the work will be done in accordance with San Joaquin County II , and rues n /re atio s of the San Joaquin Local Health District. l (Signed)--- -•--••------------- , �-L---- -ice (Owner end/or Con trectar) " 8y----------------• --------------------------------------------------------- - ....(Tit le)----•-------------•--------------------- _ (Plot plan, showing size of lot, loceflon'of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-----Tc.CI-r_©._- ------------------------------------------------ DATE------ ------ - REVIEWED $Y. ------ ------------------ -•-•- DATE--------- BUILDING PERMIT ISSUED--------------------------- -------------------------------------- DATE. Alfierations and/or recommendations:--- ----------------------------------------------------------------------- ______________________-__ -- I------ -R a FINAL INSPECTIO Date-- ------- _'lC� ?!r t SAN JOAQUIN LOCAL HEALTH(DIS. ICT.- 130 C .130 South American Street t 300 West Oak Street ]24 Sycamore Street 205 West 9th Street Sleekton,California .� a Lodi,California Manteca,California Tracy,California EQ 9 REVISED 0.99 2M 8-61 ATLAS