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FpR OFFICE USE: �-� ---- - ------------ ------ -/ APPLICATION FOR SANITATION PERMIT Permit No. ..... .4�3-------------------------------- ------- -- ------------------ --------- (Complete in Duplicate) Date issued __9.__ ----------------------------------------------------:_._._ 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. JOBADDRESS AND LOCATION------------- �------------�- 5-n---------- -------------------------------------------------------------- ` rPhone Q $ZZ Owner's Name----------- -------------L&----- --�- Address------------- ---- -S "`"' ------------------ ------------------- ---------------------- ------------------------------- ------------------------------------------------------------- Contractor's Name =° �. J I _t? 2r4_�--k-----------4------`� `� `�' F t` Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ------- Lot size ______'t-—__--_ - r.1*L.. -----.--•_----------- Water Supply: Public system ❑ Community system ❑ Private'�j Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (1f yes,date______--------------) No Ej" New Construction: Yes ❑ No H`� FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) L eptic Tank: Distance from nearest well_________________Distance from foundation--------------------Material-.._---___-.___.__._-__.._______----------_.._.. }� ❑ No. of compartments-------------------------.Size-----•--------------------------Liquid depth---------- ---------------Capacity------------------- -- Disposal Field: Distance from nearest well_________________Distance from foundation_-_-______.___-.__.Distance to nearest lot line-------------.__. 00 ❑ Number of lines---•--------------- ---------------Length of each line------------------------------Width oftrench-ti-----------.--------------------- In Type of filter material_________________________Depth of filter material-----------------------Total length---------k-------------------------------- Seepage Pit: Distance to nearest well-10-0_.- ______Distance from foundation-----1f1__------.Distance to nearest lot line----S_--_._._ Number of pits-------.`L----------Lining Diameter--------36-- ----Depth-------------yf----------- V 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----------------------------------------- F1 - ---___.___________._______--________-.❑ Distance to nearest lot line--------- ------------------------- -----------------------------•------------- ------------------------------------------------------------- N Remodeling and/or repairing (descriiae):--------------a-j--d------------------OFY_l_S_77!-11-`}------------ T–,e-K?--'--------------------------------------------- ----------------------------------- -----------------------------•----------------------- ---------------•------------------------------------------------------------ ----------------------------------------------------- ----------- ------------------ -------------------------------------------------------------------------- --------------------•------------------------------------------------------------- ---------- ------------ ------ r 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. (Signed(--------------- ....... 'u `0.` '--- --0------S Y`zr----------o .' ----- ---------------------------------------._(Owner and/or Contractor) By:------------- -------- - -------- - ------ ----------------------------------------------------------------------(Title)) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- • --- - ---------------------- ---------------------------------------- DATE----- ---------------------- ---- REVIEWEDBY-------------------------------- ------------------ ------------------ --- -------------------------------------- DATE------------------------------------------- ---------------- BUILDINGPERMIT ISSUED------------------------------- -----------------------� -------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:___ -- Inu +�--K-- �- �- -- - - --------------- ---------- ------------------------------------- --•--------------------------------------------------------------- ---- - -- -- - - ----------L------- ----------------------------------------------------------------- ----------- ---------------------------=-------------------------------------- -------------------- ------- - --------------- ------------------- ------- --------------------------- -- ------------------------------------------------------------------------ -------- ------------ --------------------------------- --- FINAL INSPECTION BY:....... -. rr.--------------------------- -- 7 -1�'3--------- Date---- �-- ---•---- ------ --------------`----- - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stocklon,California Lodi,California Manteca,California Tracy,California FS 9 ReV15£D 2-59 3M 3-'S3 F-P-C[].