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FOR OFFIC' USE: /_____________________________� 7.6-- APPLICATION FOR SANITATION PERMIT Permit No. ._ � !___.._ ------------------- ------------------ ----------- -- (Complete in Duplicate) ------------- This Permit Expires 1 Year From Date Issued Date issued __/1Z�6V Application is hereby made to the San Joaquin Local Health District for a permit to constr c and i stall the work herein described. This application is made in compliance with /County Ordinance No. 549./� ��If�I'7ein��r•� J06 ADDRESS ACATION-•n� ` 1._ D1-- r '' � Q--d• �!!I' �! Owner's Name--- ----- 1 y .S-d-^1-------------------------------- - ---------------------------- ------ Phone------------------------------------ Address ----------------•--- oe Ile /� Z '�f Contractor's Name------------- a ------•---------- Phone_-------•------------------•------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -__1._ Number of bedrooms..___ Number of baths __ ,Lot size __________________________ Water Supply: Public system ❑ Community system ❑ Private epth to Water Table 77- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,date_ _______ _________ I No New Construction: Yes [ to ❑ FHA/VA: Yes F±�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) If Septic f Distance from nearest well_.. Distance from foundation__/Q.___.__.MWial---�_ f`� C- ------- -------------------- --- _______ .�6 X YO.-----Liquid de th_'V .. ... Ca acit �P CJ No. of compartments_-- -- __-- _-Size- ---•_._.-- -- G P. --/�-- --- P Y---�--- ----------- Disposal Fie! • Distance from nearest well__,! V-_Distance from foundation--/Z.....Distance to nearest lot J___ � Number of lines-------------------------- -- Length of each line------------------------------Width of trench-.a'_-f1----_.11-___-------------- T e of filter material_ +_` a th of filter materia!____.y._.��_____Total length-/-J—V-/ YP LL A O ------------------------- Seepage Pi Distance to,nearest well--- - -_-Distancem foundation/Ca--- _____.Distance to nearest lot lines____.__ Number of pits__.'__-------Lining material_ .C__4%"'_ Size: Diameter•?---f-------Depth..cA,. 'f +^e;;r!__.. 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.____ __________________________-.___--- P ❑ Distance to nearest lotline--------'-----------------------•--- ---- ----------------------- + Remodeling and/or repairing (describe):-----------Z-1--i _-��l� -_-_ _ �- ------------------------ • ----•------------- -------------------------------------------------------------- ------------------------------- -----------------------------•------------•------------------------------------------•---••----------------------------------- ---------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------{--------------------------------------- - ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statelaw rules and regula '_ns of the San Joaquin Local Health District. {Si 9ned} ---- ----- -- - - - ��~_ (Owner and/or Contractor) BY:---------------------------------------- - - - ------ -- ----- -------------------------------{Title} --- - --- ------------ (Plot plan, showing size of lot, c n of system in relation to e , uildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --------------- --------- ---------------- DATE_ �! 411 ------ ----------=------ __, REVIEWED BY --- -_w-.._.- r------------------------------------------------------------------ DATE r BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE BUILDING ------ ------ Alterations and/or recom ndafjogs:---------- --------------------------------------------------------------------------------------------------------------------------------------------------- -74-Y--- ' y.�.__o c*,tC,------------ "----------------------------------------------------------- --•------------------------------------------ ----------------- ' --- ----------- ----- -- -----------------Gam -- - ------ ----------------------- --------------------------- f FINAL INSPECTION BY:-- -- ----.C.'.4C7.;-- ------------------------------ Date--------�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street :11 Lodi,California Manteca,California Stockton,California Tracy,California F.P.CO.