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Fi:DRPFFICE USE: -------------- '------- Permit No. .. APPLICATION FOR SANITATION PERMIT --------------------- ------------------ / ------------- ------------- ------------ (Complete in Duplicate) Date Issued ._��. •- -(�.--• ----- .--_ -_ .4 ---" ---------__�"""` This Permit Expires 1 Year From Date Issued hereby made to the San Joaquin Local H This application ealth District for a permit to construct and install the work herein described. Application is n is made in compliance with County Ordinance No. 549. i - ---------- --- --------------------------------- 7, JOB ADDRESS AND LOC TION--------- - Owner's Name _ Phone -------------------_-•--- Address---------------------------------- �u / "S { f J[ C°' ........ Phone.------ L� Contractors Name------------ ` . r - - -�_ Installation will serve: Residence Q!� Apartment House ❑ Commercial ❑ Trailer Court ❑ ryMotel ❑ /Other ❑ ber of bedrooms --L Number�of baths _(----- Lot size ------ -- _r--x S "r------------ ----- Number of living units: _1----- Num k Wates Supply: Public system ❑ Community system ❑ Private Depth to Water Table ZOO ft. Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe[W Hardpan ❑ No Previous Application Made:. (If yes,date--------------------) No W.New Construction: Yes E] No 5;r-- FHA/VA: Yes El r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f -• - Material-------------------------------------- ------ -- Se tic Tank: Distance from nearest well-----------------Distance from foundation__-_----"- _--"- - Capacity------------------- 1544IV6 No. ents------------------ -of compartm ----Size--------------------------------Liquid depth ` ! r Distance to nearest lot Iine.__7 --Fs�, Disposal Field: Distance from nearest welk..�_�___--_.Distance from foundatio __ -------- v ' Len th of each line.._f---F- -�-------Width of trench-__- ------------------•-- Number of lines:. ---C/ 9 cr g Type of filter material_-_�•_�- CrDepth of filterterial-_--.-_.-- r Total len th_ -1- -- -=------- ------------ - ;�_,,�_.---.Distance to nearest lot line_." -__G------- Se epage -.-_-_Seepage Pit: Distance to nearest well_- Distance fr��n foundation"__ J? Depth__"2- ----- Number of its._- "- _...-_-------- � _Lining mate rlal-/- __._�Qri+�Size: Diameter____-- -_ r ' Cesspool: Distance from nearest well-----------------Distance from foundation------- ------- Lining uid Capacitial y gals. ❑ Size: Diameter-------------------------- ----------Depth--------------------- ----------- `--------------- .,q p y-_--------------------- r Distance from nearest well---------------------------------- - Distance from nearest building----*:-------'--------------------------- Privy: ------------------------------ Distance to nearest lot ine-------------------�---� ----------- --------- ---"�-- - � Remodeling and/or repairing (descrihe�:-___. I , _ ( . l ------------------------------------------------------------ I --------- ------------------------------------------------k---- ------------- 3 - ------- ---------------------------------------------------------------------------------------------------- - ! hereby certify that I have prepay this application and that the work will be done in accordance with San Joaquin County ordinances, State laws. an rules end re lations of +h San Joaquin Local Health District. I _ t_ Owner and/or Contractor) t -- -- -- -------- -- -"- . (Signed) #L (Title)- - - -- '--------- ------------------ --- `�-�------- -- - - - --------- '--�-� reverse side). y'-""""":----�--- �- - buildings,,etc., can be place (Plot plan, showing size of lot, location of system in rel ion to wells, n j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE---- - ---------- ------------------------- i � --------------------- DATE-----------•- - -•---- - ----------- ----------- ---- REVIEWED BY----- ------------ ---- --------- ------ ------------------------=- ------- ---------- ---------•-•- ------- IBUILDING PERMIT ISSUED-----------r------------------------- --------------------------------------------------------------- Alterations and/or recommendations:------ ------- - -------- ------f�----------------------------------------------- ------------------------------------------------------- •---------------•----•---- --A(" ----------------------- _ - --- --------------------------- ----------------- -- Date- ---'-�-��--P-�-'s{--- -- ---------- --------------------------------- FINAL INSPECTION BY:".. --------''�------------- ------------- --- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Norelion Ave. 3o0 west oak Street 124 Sycamore Street 205 West 9th Street I Lodi,California Manteca,California Tracy,California Stockton,California _ F.P.CO.