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FOR OFFICE WE-—f ------------------------------------------ ------------- --------------- -------- --- - ------ ---------------------------------- ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- ---- --- -------------------------------------- Duplicate) '(Complete in �—�0— P r From Date Issued 1 Y 7— P7 te faded -------------------------------------------------------- This Permit Expires l Year Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 'r This application is made in compl- ce with County Ordinance No. 549. JOB ADDRESS AND LOC TXN15i 1>r= l '1f =fir ----- -S ----------------------------------------------- Owner's Name--------------- @F� �`' - _�.. - _ Phone Address-----------_R _-----------.- 'sca4 - -------------------------------------------------------------------------- Contractor's Namelt,{- _ -- ------------------ ------ --- Phone----------------------------------- Installation will serve: Residonce Apartment House ❑ Commercial ❑ Trailer Court E] Motel [:] Other E]Number of living units. ------ - Number of bedrooms ---S_ Number of baths.----- Lot size -- -C fi-�---------------------_.._ } Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 357it. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe ❑ Hardpan Previous Application Mader (If yes,date....................) No Construction: Yes ❑ NoiA/VA-: Yes ❑ No i TYPEOFINSTALLATION �ANDSPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------- Material---------------------- -----------------------I ' E)(%3;tl No. of compartments---------------------- --Size----------------------------:---Liquid depth--------------------------Capacity---------------------� Disposal Field: Distance from nearest well -------------Distance from foundation------------ -------Distance to nearest lot line----------------I IEXjff,-TIe1/& Number of lines-----------------------------------Length of each line-----------------------------.Width oftrench---------------------------------I Q Type of filter material._-.._------------------D,e.4 of filter material-----------------------Total length-.-._-_-------_--_- -----_ w yS Seepage Pit: Distance to nearest well____ ' tl istance from foundation---1 -----_- .Dista e to nearest lot line-__ Number of its.___--. - g Z/X p I �- p �-----------_Linin material-ROCK Diameter--- ---- - --- -----.Depth Distance from nearest well-----------------Distance from foundation___--------_----.-.Lining material-..-.___----_-------------____-_---I . Size: Diameter--------------------------------------De th---------------------- - ------- -------------------Liquid Capacity alsl Privy: Distance from nearest well---------------- ----------------------- --------Distance from nearest building------------- (� ❑ Distance to nearest lot line ----------------------- --- ------------------------------------------------------ --------------- ---- - ------------------------- Remodeling and/or repairing (describe)-- - ---------------------------------------------------------------------- -------------------- ------------------------------------------- Hi --------------•---•------------------------------------------------------------------------------------------ ------ -------------------------------------------------------------------------------------------------------- .I -------=----------------------------------------------------------- - ----------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - I hereby certify that I have prepared this applica+ion and that the work will be done in accordance with San Joaquin Coun+jib. ordinances, S ate laws, and �ru�15nregulations of the San Joaquin Local Health District. -{Signed)_-- -- ` -- '�,/ ,(, ( V -------------- -------.------------(Owner and/or Contractor) ' F By-----------------------------------•--- ------------------- --------+'------ -- -- -- - - - {Title)=- T� (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). pp�� FOR DEP MENT llSE ONLY APPLICATION ACCEPTED BY------ --1_-ice.-.0 -- --- -- - ------------------------------- DATE__ - - f c ------- -- - ------------------ REVIEWEDBY------------------------------------------------------ ------- -------- --------------------------------------------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------- ----—-------------------------------------- DATE------------------------------ Alterations and/or recommendations-------- -------------------------------------------------------------------------------------------------------•------------------ ------------------------------------------------------------------------------------------------------ -----------------------------------,:--------------------------------------------------------------------------------- --------------------------------------------------------- -----------------------------------------------------------------------------� ------------------------------------------- --------------------------- --------------------------------------- - -- - -------- ----- . - ------------------------ ----------------------------------------------------------------------------------- KVFINAL INSP N BY:.. Date------------------ �� "/ ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.liaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi, California" Manteca,California Tracy,California 1 r•-a.c o.