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FOR OFFICE USE: p ----------- Permit No. _W/1 .. ------------------ ------ --- - ---- APPLICATION FOR SANITATION PERMIT -_-- -- --------. (Complete-in Duplicate} Date Issued _/-�-3---rte-- _ _ W. 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. r _ 2. 7 �--1 a �✓ --------------------- ---- --------- JOB ADDRESS A LOCATION___ 9 l / p -Q Phone-- .-- i�•-�f^' Owner's Name_-___(._ __ -- - ' �+ RI t Address f -1 - --- ---- ry 2 ---------•- -- --- -- Phone.d-/'r.�,3- - --------- Contractor's Name_-""-/00_-,0F_-_ ----•---- - ----- -------•--""--- _ Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence F Apa ment House ❑ ❑ r��,e�/ . Number of bath -------- Lot size _- -_-__--�"T ---------------------- Number of living units: __ -- ___ Number of bedrooms S - Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table ) ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam t' Clay Loam ❑ Clay ❑ dobe❑ Hardpan ❑ ------- ) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No,� Previous Application Made. (If yes date._.___..__., � . TYPE OF INSTALLATION AND SPECIFICATIONS: _ �(Na- eptic"Fa'nk o�ce�pool`permitfed�#`'p"ublic`'sewer`is-available=within�20U--feet.) ------ ------------ ---- ----- I Septic Tank: Distance from nearest wall_________________Distance from foundation_______._._._._ _..Material __. .._ --- _ I ❑ No. of compartments----- ------------------Size------••------------ -------- Liquid depth--------- ------- --- ----CapacitY---------------- ------ Disposal Field: Distance from nearest well.-.5707-- Distance from foundation-_ "-.___._...Distance to nearest lot line___. Len th of each line--.-------., 0-�- ---Width of trench.------------Z------- ------------ +,�] e/ Number of lines -_.__-- I-------- g x. ! ----Total length--------------- ------------------- Type of filter material__.�� -. -.-Depth of filter matenaL_...__1_ .. �_______.Distance to nearest lot line---- __.._ i ` -"--Distance from foundation____ �J Seepage Pit: Qi stance to nearest walL.__�d"-_-- _-"Depth_yX- - -fo f Number of pits-1 -------I--__.Lining material----�,6� --- Size: Qiameter------------- -- Cesspool: Distance from•nearest well _----".___._._Distance from foundation-..._.__.- Lining material_____....._.__.__._.___--.--.-__._. Ca acit gals. ❑ Size: Diameter. ------ ----- --- --------- Depth --------- ----- ----- -----------------.___LiquidP Y----- -----•---- ------- Privy: Distance from nearest well.---------------- - ------------- --- ---------Distance from nearest building----------------------------------------- ------------------------------- ❑ Distance to nearest lot line ...- ---------- ----------- ------------------ Remodeling and/or repairing (describe)------------------------------------ -" ---•------------'-""-""-""--" A ------------------------ ------------•---------- ------------------------------------------------------------ ----------------------------- - --------------------•.-----------—---------- ------•------------------------- ---------------------------------------- I-hereby certify that I have prepared this application and that the work will be done in acccoco rdance with San --- ------n Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ;ZeSi ned -ff. ------ -- ---------------------------------------- ( wrier an r Con ctor) O d/a tra r;,�,:�(1rtrt e — [Plot plan, showing size of lot, Iota kion of system in relation #o wells, buildings, etc., can be placed on reverse side). ` r FOR DEPARTOITNT USE ONLY ►. • ----------------- ------- ------- ------- ---- ------ DATE-- ----1----2__-- ------ -------------- -- # APPLICATION ACCEPTED BY----.-"� F DATE------------------------- --------------------------------- REVIEWED - - - - REVIEWED BY------------------------ ----- = - r ------ ------------------------------ ........ --•--------------------- ------------- BUILDING PERMIT 155U - - -- ns:--- ------- ------ -------- - Alterations and/or recommendatiol ------ ----------------------- --------------------- ------------------------------------ E ! Date-- - --------- ----- ---------------- --------- FINAL INSPECT-10 SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi. California Manteca,California Tracy,California Stockton,California . E.K.9 21%1-67 Vanguard Press