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- �rc��.�rri�t USE: ` f //� --- --------- -� ----- -----------------------------------____ �---_------ APPLICATION FOR SANITATION PERMIT Permit No. ...1112%!� _.- (Complete in Duplicate) -------- --- This Permit Expires 1 Year From Date Issued Date Issued�I? bI-- 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. JOB ADDRESS AND LOCATION___.__-- 7�-.-J-4----_-- illeolee------- Owner's Name---------/_./_.ems"---- f e��s�-------- ,r ------------------------- --------------------- ----------- Phone-------------------------------•---- Address------------------------- Contractor's Name r "--- -------------------- ---------•------------- Phone-------------------....--•-- Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/-- Number of bedrooms -C-A— 4umber of baths /--- Lot size ------- Water Supply: Public system 541C;ommunity system ❑ Private ❑ Depth to Water Table 4�7 ft. Character of soil to a depth of-3-fee*z--.Sand-0 _Gravel,❑..._Sandy.Loam ❑ Clay Loam[:] Clay ❑ Adobe Earf=lardpan ❑ Previous Application Made: (If yes,date...______----------) No 5;--11—ew Construction: Yes o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION A D SPECIFICATIONS: ! (No septic tank or ces ool permitted if public sewer is available within 200 feet.) Septic Tank: Distance rom nearest weft_______________ Distance from foundation/40 �= No. of compartments Size__ fi � Liquid depth--- lam•---------Capacity----F-d--O-- ~ Disposal Field: Distance from nearest weft.................Distance from foundation--- --------------Distance to nearest lot line._. ____ i Nu'mE�er„ .. lines---------- -----Length of each line-----.--,J�i�-------- ---.Width of trench_._5�-�_ ---_.- Type of.filter material___JPXWP1�"-Depth of�fil4r-material_._. V______Total length_______ __._______ _-_- ------- Seepage Distance to nearest well--- "'_______Distance from foundation/101-------Distanc to nearest lot line__- �_____. Number of pits--------J------------Lining material__. G- ----.Size: Diameter__.3�__--------Depth-------��___-!!^�f Cesspool: Distance from nearest well-----------------Distance from foundation.___---------~-----Lining material___...___----________________.___. W ❑ Size: Diameter-------------------- -----------------Depth-------------------------- --- ---------------------Liquid Capacity- .------------------ --•--gals. Privy: Distance from nearest well-----------------------------------------------..Distance from nearest building------_._____._ ❑ Distance to nearest lot line. Remodeling and/or repairing (describe):_______ _jE-7- f --/1i!--- --•--------------•----------------•------•------------•- / ----------------- - ---- - � -- -tea- - ----------------- ---- ------ - ----Q ----- I hereby certify that I have prepared this application and that the Work will be done in accordance with San Joaquin County ordinances, State ws, and ruE d regulations of the San Joaquin Local Health District. (Signed) ...... .. ..........1/ --- - [Owner and/or Contractor} BY� ---------------- M -i4[ - �° (Title) (�-. ----------- (Plot plan, showing siz o of, location of system in re ation to wells, buildings, etc., can be placed on reverse side). ��rr FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY c__ �. ----------------- - --------------------------- DATE cla" 6 REVIEWED BY. DATE ------------ ------•----------------------- BUILDING PERMIT ISSUED-------------------- ----------- --------�---- - -------•---------- ------------------ --------- DATE-------------------------- Alte��o aryl/or recomm nd tions -�-- . ---__ -- ----------- ---------- ------------ — G. -- - - -------------- --------- --------------------------------------------------•- -------- ------ ---- ----------------------------------------- --- --------------------------------- FINAL INSPECTION BY:...... 4-d'-----�- - f/ - ---- �---�--------------------� Date-- /7.- `.X---lQ _------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 5tocktan,California Lodi,California Manteca,California Tracy,California F.F,C O.