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FOR OFFICE USE: `- �'�� :.ri� ,,-� /`�T / Permit No.a L. _J..._ - 1 ----------------/-- APPLICATION FOR SANITATION PERMIT � (Complete in Duplicate) Date Issued __�___l_. ----.� ------------------------ -------------------_ --"_-- This Permit Ex ires 1 Year From Date Issued _ --------- d. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe This application is made in compliance with County Ordinance N . 549. ---------------- -------------------------•-------•-- 13 JOB ADDRESS AND LOCATION--------- Owner's --- - Phone { Owner s Name__---_jLU_ ------t---- --- -------------•-------------------------- -------------- - --------- - Address--------•--��Z-- -- ----------••-------•------------------- ------------------ ------------------•--------•---------------------- ----•-----�----------•-------••-- rPhone----------------------------------- Contractor's Name - 7 -------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other - Lot size --- ---------- -------------------------------- Number of living units: - .-- Number of bedrooms -' - Number of baths _)— : D Water Supply: Public system ❑ Community system 11 Private 2'--Depth to Water Table Hardpan E]Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam E] ❑Clay Loam Clay ❑ Re No New Construction: Yes ❑ No T FHA/VA Previous Application Made: (If yesdate : Yes E] No r TYPE OF INSTALLATION AND SPECIFICATIONS: t l (No septic tank or cesspool permitted if public sewer is available within 200 feet.} i - 1 / ` ---------------•---- Septic T k: Distance from nearest well---------Distance from tpuundation_�X!---_-_______.MatenaL___ __________________ No. of compartments-----c2 -.____-__ ---•-SizeS'-4A-X Liquid depth �'.-.---------Capauty..l_G- ----- Dis osal Field: Distance from nearest well._•4FV.._.....Distance from foundation:----------------Distance to nearest lot line-- �---------- t p p Number of lines -- Length of each line "!Q --------------------Width of trench. -- -s-- --------------------- -- Type of filter materi2l' L_ _-Depth of filter material_..I ____--___:._Total length_--. ------- f v f Seepage Pit: Distance to nearest weIIJ09--- -___-.__Distance finfoundation-------------------- aD-titer. Dista nc01 e to Depth---. loft I�i-� ---_---_ Number of pits-__' ------------- LiningImateria!____ . .- f Cesspool: Distance from nearest well-----------------Distance from foundation-- materia ____...--------------------------- _Liquid Capacity gals. ❑ Size: Diameter---- -------------------=-----------;Depth------------------------------ ---------- i . #: -_ ` - -----------------------Distance from nearest building----------------- ---------- ---- ------ Privy: - -- Privy: Distance from nearest well________________________ _ r - ________________________ __________________________________________________________ ❑ Distance to nearest lot line----------------- - --------- ----------- ----- Remodel• gond/o i p g ----------------------------------------------------------------- e Erin etlribe):--.__' 4'f` ----- . t3 l------�- -- -- ------------------- G'N --------------- --••---- -- ------ t -------- i �/ , --------- 1 l hereby certify that andhave rulesprepared regulations application the San JaaquinhLocalwork Heawill ltheDisdone •r a}n accordance with San Joaquin County ordinances, State (1s (Owner and/or Contractor} Sined L =------------------------------ --------- -------- ------- ------------------- ------------- { 9 )-------------- ------------------ Title - ---------------------------------------------------------------- ---- - (Plot plan, showing size of lot, location of system in relation to we11s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------- DATE----1 ------- -------------------------- APPLICATION ACCEPTED BY --- DATE-------------------------------------------------------- --- REVIEWED By --------------------------- -- -------------------------- DATE BUILDING PERMIT ISSUED----------! ------- _ - - -------- Alt retions of d/oorr recommendations:______ _- --- F iA_&c'rA....oS ��ealh---------------------------- --------------------------- --------------------------- f ---------------- ---------------- ------ ------- - ...----- - r ' I ," Gr r TicX4� _- 74, -- ------- ------ �P fa FINAL INSPECTION BY:..-- - -_-- -- Date__ i SAN JOAQUIN LOCAL HEALTH DISTRICT 11101 E.1FaseTr9n'F.varx 300 West Oak Street 124 sycamore Street 205 West 9th Street I Lodi,California Manteca,California Tracy,California Stockton,California > F.P.Cd.