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FOROFFICE USE: y K w. ' ---------- -------=------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- -------------------- -_: ------------------ (Complete in Duplicate) f �1 s�...�. -- - , _ Date Issued -/�—� ^ -------- 7 This Permit Expires 1 Year From Date Issued Application is hereby made to the San.�daquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. 1 S�s C-ALOt4 •� JOB ADDRESS AND LOCATION__�S__1_D�----- "-1_CI-L _ ---- ---- a •--- �...Z✓�� , ----- Phone------------------------------------ k'r''::. Owners Name------------- ..._.. l�!. Q/�1 Address.- _: .._. ." , -----------------------------------------------------------------•----------- Contractor's Name_ANT-H0N- 4___.5`-4f4-=-----------------------N1p(Ir ------------------------------------- Phone------------------ ----••---------- 4::' Installation will serve: residence Q"Apartmant House ❑ Commercial E] Trailer Court E] Motel Other El Number of living units: __�____ Number of bedrooms _._r____ Number of baths __L____ Lot size .___..._ 1 _ Water Supply: Public system E] Community syst m ElPrivate ��Uepth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam [Clay Imam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,'date--------------------I No 9---New Construction: Yes [`1'o ❑ FHA/VA: Yes ❑ tlNo []� TYPE OFTINSTALLATION AND SPECIFICATIONS: Septic Tankse tic tank tancesfroml: j ' ( p P perm>�d if public sewer is available within 200 feet.) : n . f��--------.MVae ' I_�a/iOC�ET nearest well'',? __.__Distance from foundation___ _. 71 --Z `� ppNo. of compartments----------------=--------$ize�_-��_�_� -.---Liquid depth--- - ---�Capactty____-�_-- Disposal Field: Distance from nearest well__J� __._Distance from foundafo n___.119------------Distance to nearest lot line.----- "x, Number of lines---------- __------------------ Length of eac h line_,__�-_______--.Width of trench_..__.___._- ?��__.� ki Type of filter material----R.l7C <.-.__Depth of filter maferi ---""~_____.___...Total Eength__.._�t' _�___________-�0--___ ,� •""" n W h Seepage,Pif:- Distance`to-nearest well_____________________Distance from-foundation_____________--.-__.Distance to nearest lot line_______________._ r .i �Q� Number of pitsf`"-=-------------Lining material------. --. -----...Size: Diameter----------------------Depth---------------------•----------- Cesspool• Distance from nearest ell________________Distance fr6 m foundation__._.-_---..___._.Lining materia!_____-_________.______-------------- . --___.______ Size: Diameter. - - b. .. p ------------- ------- -----------.Liquid Capacity--------- ----------------gals. ❑ '�. Dept -.-_Distance from nearest building Privy: Distance from nearest well-- --- ------------------- - --- ----- g------------------------------------------ N -------------------- ------------------ ❑ '� ---------- --- ----------- ------------- Distance folnearest lot line--------- - 4 - ...+�..----- --- ----------------------------------------------- Remodeling and/or repairing (describe)---- �- -------------------------'--- -------------------------- - ---------------�------------ - - -- -------- . . w ---- _------ ----------------------------------------------------- ----------- ----- = { `_ --------------------------------------------- t -------------------- ------------------------------------------ _ f */ -----------_ ______________________________ ______________________ � _ ____________________________. ___ -------------------------------------------- ----------------------------------- 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. [Owner and/or Contractor) __(Signed}-. �--- �_ _ � �.� -----------� �---------------------------------------------------,. - - .---- ---- By:-------- —---------------------------------------------------------------(Tit --------------------- -- ------------- -------- -----(Tit e)------ ----------- ---- ---- ---- - (Plot plan, showing size of,lot, 6c t in of sy stem in relation to wells, buildings, etc., can be placed on reverse side). ;r FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY---------- ------------------ DATE-----�1 � ` REVIEWED BY---------- ------------------------=------------ --------_---- _ ----------- ----------------------------------------------- DATE---------------------------------------------------- �oft BUILDINGPERMIT ISSUED--------------------------------------------------------`-l-'---------------' -�_�- '��:';----- DATE------------------------------------------------------------- ---------- Alterations and/or recommendations:_"----------------------------- --------------------------- ----------I--------------------------------------------I----------- -----•---------------------------------- ------------------------ -------------------------------------------------- ------------------------------ _. 1,...— 4.1.t t t F t (4.� i L S a at_.%_3..r t s lrP---------------------- f - - Date._-._------- - FINAL INSPEC ------------------------ .f,• - 'SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street y, Slotkton,California Lodi,California Manteca,California Tracy,California F.P.CC. ^' ,