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FOR OFFICE USE: - - r r APPLICATION FOR .SANITATION PERMITPermit No. A��Z ----------- ------------ - -- -----------'-- _ (Complete in Duplicate) Date Issued -------L------ ------- 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 descried. This application is made in compliance,with County Ordinance No. 549. s -------------------- ---------------- ------------- JOB ADDRESS AND LOCATION - ------------------ Owner's Name----- ---- Phone__ yap Address---- --- ------------------- -•--- -------- --------•-- -------------- '-------- I .-. Phone__ _ Contractor's Name-------•-•------- '-`�4 ------------- ------- .r__. --------- Installation will serve: Residence [VApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s Number of living units: __- Number of bedro ms __ -- Number of baths _2_ Lot size ----- - --- ----- _.____________.._-_________ Water Supply: Public system E] C'Community system: ElPrivate [Depth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam El Clay El Adobe [ ardpan 11 = i Previous Application Made: .(If yes,date-../-1' :_v-I No �New Construction: Yes El No q�FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) k I t ---------- ------ Septic Tank: Distance from nearest well_________________Distance from foundation--- Matenal-___ --__.._-_____. ..__ g / �/ p2 Size. S 9 Liquid depth----- =...... .Capacity--- No. of compar#mems______ _____________ _ Disposal Field: Distance from nearest weld:S D___�-Distance from foundation__9 = J__----Distance to nearest lot lina�� ____ Number of lines__!----�------- Length of each Iine�L1__e_0-----ate---Width of trench....... _�---------------- Type of filter mat}erial-_-_- r�`1-0�-k Depth of filter,.material__--/ ��- ,_ .-Total lengthri-----f -:a------------------ - "' F r , l� ` )N4-111` , Seepag it: Distance to nearest well__. t Q___ __Distance m foundation___ _______-Distance�to nearest lot iine_�------__.._ Lining material- ---Depth---- f - Number of pits.--- . ac fit'- Size: Diameter----_-- _ _ Cesspool: Distance from nearestawell-----------------Distance from foundstion---._.-.---______..Lining material------------------------------------- - ----- ----------------------Depth-------------- ------- # -------Liquid Capacity----------------------------gals. EJ Size: Diameter--------- _ 1 xl Privy: Distance from nearest well ----------------------------------------- Di4tance from nearest building____._._______._________________..___..4._ ❑ Distance to nearest lot line--------- - ----------------------------------------------------------------------------------------- Remodeling and/or repairing (describe): -------------------- ; , A # ---------------------•------- ----- -----------------,4 s J -'.,t. t 4 ll ------ ---------------- •------------------------------------------------------ ------- -------------------------------------------------------- --=---------------- i _ I hereby certify"tifat I have•piepared this'application and.+hat,•thejwork will be done in accordance with San Joaquin County ordinances, St a laws, and rules and reg tions of the San J aquin Locaf,Health District. t - _------Owner and/or Contractor) (Signed)_ -------------------- -- BY:----------------------------------------------- �- -------: -- - - - - --------------------------------(Title]_ -- ---------- -.----------------- (Plot plan, showing size of lot, location of system in rela#io wells, buildings, etc., can be placed on reverse side). Y l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- I---- -------- 11l - : ., - DATE �� / .: REVIEWED BY--------------------------------- ------------------------------------- DATE------------ - ------------------------------------------ BUILDING PERMIT ISSUED-------------- ------ Alterations and/or ----- ATE--- ----------------- ---- --------------------- recommends+ions: _GL'--�' F - -- ----•---•-------- - S -----------------------------------•---------- ---------- ---•-- ---------------------------- j---------------------------------------------------------- .1. -------- ----- ------- --------------------------- ---------------- ------------------- - -------------------------------------------- •--- - - ------------------ ------------ ------------------- -- ---- ----- ----- ------------- ------------------------------------- � G FINAL INSPECTION BY:..-- ---------------- ----------- Date-_ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Av's. 300 West Oak Street „ 124 Sycamore Street 205 West 91h Street i Lodi,California s ' Manteca,California Tracy,California Stockton,California F.F.CG.