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FOR OFFICE USE: "a -------------le,---14.1x------- - A. r APPLICATION FOR SANITATION PERMIT Permit No./..1_/g A ._. ---------------------------------- , ------------ (Complete in Duplicate) Date Issued ------ -------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND LOCATI N----alOYE.. I�J�I �. � /� ' ---- -------------- ------------------------------------------------ ------ Phone------------------------------•- Owner's Name-'--��-- - ------ "- - - - ---- ---•-- -------------------------------------------- - --- Address -----------------------------------------------------------•------------------------- ----------------------------------- Contractor's Namezear•--1��1�e�------------------------------------------------------------------•--•------------------ Phone---------------------- ----------- Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: ___"'__ Number of bedrooms _ _ Number of baths . ___ Lot size --tQ-i-------------------------------- Water Supply: Public system Community system em ❑ Private ❑ Depth to Waite Table A� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8'--H-ardpan ❑ Previous Application Made: (If yes,date---------_,--.-----) Not® New Construction: Yes �Vo E] FHA/VA: Yes E] No F-1 TYPE OF INSTALLATION AND SPECIFICATIONS: .w ' �} (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I i ' j J P ____Liquid de Mate 'al iW Septic Tank: No. ance from of com artme}St well_._�___.__Distance from foundation----�P-�pth__._��..___...__Capacity__,?-,* �.._-. Disposal Field: Distance from nearest weii--- .........Distance from foundation__r�___'-------Distance to nearest lot line_'____-_.- �� Number of lines---- _ = Length of each line___ _" _______- Width of trench_ _____________________________ A � Type of filter material-� Depth of filter material__1 ------€_------Total length_____' r✓______--__________________ �4 t Seepage Pit: Distance to nearest well----- __.____Distance-f m fo dation_ . ____7{]isfi ice to nearest lot line__a'M_�_._ . % Number of pits__.__________�_.Lining material__ rr .Size: Diameter__a.t, ____..___Depth., 1 '-- Va Cesspool: Distance from nearest well-----------------Distance from foundation:'.________!____..Lining material---- -----___._____.__._____________ ❑ Size: Diameter----- -------------"-- -------------Dep+h -------------------------------- -----------------` Li uid Capacity_-----------------------_ 9als. . i Privy: Distance from nearest well_______________________________ ❑ -----------------Distance from nearest building______.______..______________--_--_-__._. "Distance to neares.t t t lot line------------- -------------------------------------------------------I----------------------------------------------------- - ------ L r Remodeling and/ r pairing (describe): !�'' ��"` ^�` — ' t ------ --------------------- - ---------- r ------------------ _: ------------------------------------------------- ------------------------------------------------------------------------------------------------------ - I hereby certify*tra-el 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. ! AAF- =' rContractor(Signed) ) -Title - ----------------------------------- By:------------------------------------------------ (Plot ( ) (Plot plan, showing size'Of lot, location of system in relat' o wells, buildings, etc., can be placed on reverse side). 1 ..T ( FOR DEPARTMENT USE ONLY ------ --------------------------------------------- DATE---- ` �'�= ----- -- APPLICATION ACCEPTED BY____.____�t_`�--._._____. -- REVIEWED BY------------- i -------- DATE------------------- ----- ------------------------------------------------------------------------------------------ ---------------------- BUILDINGPERMIT ISSUED----------------- ------------------------------------------------------------------------------ DATE---------------------------------------------- -------------- Alterationsand/or recommendations------------------------------- ------ ---- ---------•-----------------------------------•------------------------------- --..._._.--------------------------- ' '� 6J -�_t ---------- - •--••-- � --------------------------------------------------------------------- -�- '�. - ---------------• --•------------------------------- FINAL-" INSPECTION BY:......... Date-------- Tie. .. -�--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT" 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i I Slocklon,California Lodi,California Manteca,California Tracy,California ,