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F R OFFICE USE: J y� P Y.° APPLICATION- FOR SANITATION PERMIT ---- ------- ------------------- --- (Complete in Duplicate) __ _.�. . . This Permit res Year � s Pit Ex i 1 Yr From Date Issued Date Issued ____ ' ______ --- - - -- a Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a lic� i�pmade�J'n 11N n h County Ordinance No. 549. qq • J08'A�RESS 71N LO� Owner's Name1�� '` S S'FIp Phone__, - r Lg .�i�' - . . *----- -----tA --------------- ------ - ��----------`-----Coca--tris--'------------------------ Address----- •----------•----- �/ / Contractor's Name---- Phone___7_ �R.3f t� --- --- -•------------ - ------------------------ Installation will serve: Residence ❑ Apartment House [I Commercialrailer . ou t ❑ Motel E] fher E] 5 1 Number of living units: --- ---- Number of bedrooms ------ lNumber of baths, ------ o size _--- .- - Number - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-9/p ft. Character of soil to a dep ❑depth of 3 feet: Sand Gravel ❑ Send toa'm [I❑ Clay Loam Clay E] Adobe Hardpan C]� raver � Previous Application Made: (If yes,date-------------- No � New Construction: Yes R IVO ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:�'o ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic T Distance from nearest well-� --------Distance from foundation- - a------_Mate`iai--- .-.. _-------------------- No. of compartments--------f ---------t$izey-.��- -- --J----Liquid dee.`h---- -----------------CapacitY---4�-Q. Disposal d: Distance from nearest well_S7d......Distance from foundation_-�a-40------ .Distance to nearest lot line._!,5�j--V---- Number of lines----_--. ---.--.- Length of each Iine,t0Q------J ..Z � Q_6.-.Width of trench.-----.. --~----i-------- Type of filter material-_s� -Depth of filter material__ Distance to nearwell_`Q�--_._-.---Distance from fundation--- ___-.-Total length-----_____--- .OQ------, 94f--.---.Distance to nearest lot line-_0------------ Seepag est OQ Number of pits-.''�.-_-___------Lining material- ..Size: Diameter-. --- .__..-._.Depth------..e�_�.1______________. J n f i Cesspool: Dstance from i F p Barest well from foundation....................Lining material------------------------------------.-. 6 El _Li Liquid Capacity als. Z 5+ze: Diameter----I----------- - ----------"'Depth-------- ------- -------------------- - ------- q p Y----------------- ---------9 Privy: tistarce from nearest well-------------------------------------------- - --Distance from nearest building------------------------------------------ 171 Distance to nearest lot lire- ------'-------------- -------=---------------------------------------- ----------------------------------- ---------------------------------- Remodeling and/or repairing (descr1ibe):--- -------- - - ---- -- ------------- ---------- --- I t ------------`---- - -------- aQ -------------------------------------------------------•------------------------•------ -------- --------- -------------------------------------------------I---------------------------------- 04 -- ---------------------- -------- ------------------------------------------------------------------------ _jc,,�j I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SSM& laws,Aeand �les nd egulations,of the an Joaggin Local Health District.r(Signed) s 3 -- -- = ran Contract------- -- (Owner and/or or] (Title) 1 By:---------------------------------- -- ---- = f (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed o reverse side}. i r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -------------------------------- DATE---------- J --------- -------------- REVIEWEDBY----------- i---- --------- ---------- ---- ---------------------------------------DDATE------------------------------------------------------------ -ons:------- �.� f `�' ------------------•-•------------•---------------- TE----------------------------------- BUILDiNG PERMIT ISSUED--------------- ----- ---- --------- - ------------- Alterations and/or recommendations:.--- y-.�_�1___.. .--.-- -- } -------------------------------------------------------------------- -,,,, €' ---------------------------------------- 4 4- ----------------------------------------------------------------------------------------------------------------- ------------- ---------- •-------------------------- ------•-•--------------------------- -------------------- FINAL INSPECTION BY:. ms�ss}} ----------- Date---- - --- --- ------- - - -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 li.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I Stocklon,California Lodi,California Manteca,California Tracy,California I F.P.CO. 4 f Y