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FOR OFFICE USE: -------------------=------- -- -- --------------- - -------- APPLICATION FOR SANITATION PERMIT Permit No. .� ----------------------- ---------------- --- --- (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. LAT-HRO JOB ADDRESS AND LOO�tsATIO $1PE Owner's Name-------n-----4 �iY. 1.1 A- ---------F�-C 7_Kg;�R-ti---- -------------- --------------------------- Phone------------------------------------- Address - f' T . ` Ox ,LT�-�Q-�--'------------------------------•-----.----•-----------------------•------------ I : Contractor's ---------------------------------------------------- ------------------ Phone----------------------------------- - ------------------------------------------------ Installation will serve: Residence [�J'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -��. Number of bedrooms . ... Number of baths rn_ Lot size _/Ka X1 fl.�.`�_......_c�r OF AC-- 0KC> Water Supply: Public system ❑ Community system ❑ Private M" 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: (If yes,dote--------------------) No New Construction: Yes �No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Nose tic tank-,or cesspool-permitted if public sewer-is-�available within 200 feet. ..- Septic Tank: p Distance from nearest well _____Distance from foundation-----A9 Material_C..-_.....-.T'E`FL_............. 1 No• of compartments------2 --------------Size..rJ_x.l.Q.�C.. .--_Liquid depth-_fir------------------Capacity--/0.0..--- I'I Disposal Field: Distance from nearest well..... 0---..Distance from foundation----/Q__..-.-..Distance to nearest lot line._-S--------- Number of lines------------�---------------Length of each line-----140--- ------..Width of trench----.-. ------ �v3 • Type of filter material..j3.Q_ .V_1----Depth of filter material----Z?............Total length---------.-------fe- Q.----------- { Seepage Pit: Distance to nearest well from foundation....................Distance to nearest lot line------ ------- 1 r El Number of pits----------------------Lining material----------.-----------.Size: Diameter------------...--------Depth--------------------------------- -�"� Cesspool: Distance from nearest well-----------------Distance from foundation_--------------____Lining material---.-------..-..-._--------------.-.. .._171 Size: Diameter------------------------- -De th....----.-.....------...••---........--....•--......Liquid Capacity gals, ` Priv Distance from nearest well________________ -Distance from nearest building A ❑ Distance to nearest lot line----------------------------------------------------------------------- ----------------------------------- - ------ ------ i 4 Remodeling and/or repairing (describel-------------------I-- ---------- --------------•-•"--------------------------------------------------------------------------------- ----------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ -------------------------------a-------------------------------------- -------------------------------------------------------------------------------------------------- ----- _7 --- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 nd rules an eguiations of the San Joaquin Local Health District. (Signed), --------_---------- Owner and/or Contractor —$Y:------------- --w- =� � (Title) = - - - - ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY-- ' r R` O'= _- ----- -------------------- ------------------- DATE----- REVIEWEDBY------------------------------ ----- --- ---- --------------------------------------------- DATE BUILDINGPERMIT ISSUED---------------------------------- ------------------ ------------------------------------------------ DATE----------------------------------------- ------------------ Alterationsand/or recommendations------------------------ :------------------------------------------------------------------------------------------------------------------------------ --------------------------------- ---------------------------•-------------•-I----------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------------------------------ -------- -----= ----------------------------------------------------------------------------------------------------------------- --------------------------- i --------------------------- ----------------------- ------------------------------------------------- --------------------------------- -------------------------- ----- --- ---------- - - --- ----- - -- ------ --•------------------------------- - ---------------------------------1 FINAL INSPECTIQN BY: iDate 4 .. --JY._.f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California F.P.Cq.