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A 1 `CATION FOR SANITATION PERMIT Permit No. ............. �� t� om lete in Duplicate) (C PDate 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 N _ 49. t fGJI JOB ADDRESS AND LOC X10 r '� ---- ---- --------'_-..... --`-- ------------ •---------------------- ------------ - - Owner's Name__ ' ----- ------ - Phone CX Address-------- _�_.` .... _ .__s 1 '' `4��` --- :----•--:----------------------`--=.----------------------------------- ------------------- Contiactor's Name. _ Phone--•-----------------•--•---------- ----• - -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot?i ❑ Other j❑ - Number of living units: ---- Number of bede.00ms I_ Number ofebaths ___ Lot size _______________________ f 4 � Water Supply: Public system'❑' Community system-❑ Private �epth to Water Table ---------ft. i Character of soil to a depth of 3 feet: S;;�%ew Gravel [-] Sandy Loam [2 .Clay Loam [j Clay E] Adobe �rdpan Elr Previous Application Made: Yes ❑ No Construction: Yes eNo ❑ FHA/VA: Yes ❑ No Fwf F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pub'c sgwerE is available within 204 feet i Septic ank. Distance from nearest wellista c fro faun tion/ ____- ___ atera ___ __ _._ _ '" __. t _: • .. ,,. No. of com artments--.-.--- .. Size _ - -- ------Liquid tdepth--------- ---------"-Capacity_- ._ Disposa,Field: Distance from nearest wellsl )stance from foundation�o) Distance to nearest lot lin -fn!5_______. Number of {fines_________ __ Length of'each line___________ -;f__._.Width of french...___.___�_.__.r�r------- T _____ Type of filter ma#erieI-___';� '' epth of filter material--------/_ ________Total length__"___.__:__-_ a I . _ Seepage Pit: Distance to nearest well_____'_____---•-------Distance from .foundation___________________.Distance to nearest lot line:_._______ ❑ Number of p,its-'--------------------Lining material-----------------------Size: Diameter------ -----------_--Depth------------------------------ x_ I , Cesspool:• Distance from,nea.rest well- ----.--Distance from foundation ----------- f materials___________________________________� ❑ Size:.Diameter--- --------------------- ------------Depth Liquid Capacity = gal�r : ` i �r �' ---__-_-_______Distance from nearest building �r Privy: ',Distance:#rom nearest v✓ell_______________________ ' ❑ Distance'to nearest lot line--------------------------- "---------------•---------------------- =-=--------- ------ Remodeling and/or repairing (describe):----- - - ---------------•-----------•---------------•------------ ,. I y A .-.,� .71 c ------------------------------' i ------------------------------------ - _ + 1 hereby certify that I have prepared this application and that the work will.be done in accordanceith San Joaquin County s _ ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 4 - ------------------------------------------------- _----(Owner and/or Contractor) f [Signed)..---- l,.�l��---------- ---- --�-'��`�------ - - ( • ----- - ----- ' - -- --------------(Tit Br•-------------------------- -- IBI = ---- -- -------------------------- ------ (Plot plan, showing size of lot, location of system in.relaflon to wells, buildings, etc., can be placed on- reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY.. . ____ _ _ - DATE_ - -------- REVIEWEDBY---------------------------------- = =" ----------------:•-----------------.----------------------- DATE--- ------------------------------------------------ BUILDINGPERMIT ISSUED------------=`•------------------:-------------------------------------------•-------------------- DATE - == Alterations and/or recommendations--------------,,{-------------- ------------------ ----•------•--------•-- 11. - ---------- - --•-------•-------------------------= `_...... .-----{y`^'"' . =----- Lt ,-----_-T#s----�-`'�0------� c c---------`-_�'-..,--1---- ------ ---------------- ---------------------- �=��`' ` -'RA iv v, It -- --- ---- - --- ------- :. = = ---=- r--------------------- 6 Date-- ' fk -*FINAL INSPECTION-BY SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Soo kton, al'ifdrnia Lodi, Californias 1 Manteca, California Tracy, California ES-9-2M Reviseq 1.57 F.P.CO.