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FOR OFFICE USE: ------------- ------- x - -------- - ---- ---- APPLICATION FOR SANITATION PERMIT Permit No. ---------------- --------- (Complete-in Duplicate) Date Issued _-- ..__� .�1-.�_,? ------/e.___.-_--- -_---- 2. 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 described. This application is made in compliance with County Ordinance No. 549. ,�f q - JOB ADDRESS AN LOCATION----- / ?,5--- ---- / ------ Owner's Name _13Phone f ------`--- 1�' Address----------------------------•--. ----------• ----... Phone---Contractor's Name---- - -- •-•-- a—•- i 3f installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_ Number of bedrooms _'17f.. Number of baths__�-,2_ Lot size ___t;?_` ------------------- Water Supply:Supply: Public system ❑ Community system ❑ Private R Depth to Water Table �� ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made. (If yes,date---------- -- l No [J' New Construction: Yes ❑ No 0,-_'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l ` = ------------------------41xc Septic Tank: Distance from nearest well--- �.__Distance from foundation----- -------Materi i � No, of compartments------- Size_��_��_�_..-`�. _X-_��-__Liquid depth------ --- ------- Capacity_/_z3 - --- Disposal -ield: Distance from nearest weft. _ -___._Distance from foundation___��-------Distance to nearest lot line-_-S----------- Number of lines--------- Length of each line_. __94------------------Width of trench------ �f..________-_._ Type of filter material___5, Depth of filter material___- f.._.-.___Total length___X-eQ----_.------------------- r Seepage Pit: Distance to nearest well- Distance f m fou�dation__,� _ _____Distance to nearest lot line_ -____ Lf p Linin material ��------ Depth-----• S- �\ Number of its... __ g 1° �Size: Diameter_ Cesspool: Distance from nearest well -______..._.__-Distance from foundation_-_ _........... ..Lining material__._..._._-_...__-..-----_-.-- ❑ 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):__�� ___ _ _______ __ _ -�-4,t----/�- ------ '-- ---•-------------------•--•-------------------------------- -------------------- ----------------- ------- --------------------------------- ----------------------------• -•----- - --- ---- ------------------------------------------------_----------------------------------------------------------------------------------------------------------------- -------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , and rules nd r gulations of the SaA Joaquin Local Health District. 41 (Signed)--- -- -------- - '[�['{ -- ----------------- ---- --(Own and/or Contractor)` BY --------- c 00 (Title} ...... (Plot plan, showing size of lot, location of system in relation to wells, dings, etc., can be paced an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Br"xsr- 41 7----------------------- - DATE REVIEWEDBY----------------- ----- - ----------------- ._-------------------- -- DATE BUILDINGPERMIT ISSUED-------- -- - ---------------------------------------- ---------------------------------------------- DATE-------- ----------- Alterations and/or recommendations: ---- - ---- -- - ----------------------- - -----------------------------------------------------------------------•-------•----------- -------------- ---------------------------------------- -------------------------- -- --------- - ----------------•--------------------- - -- FINAL INSPECTION BY: - � Date a---�` -�-�- 7 -------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Slocklon,California Lodi- California Manteca,California Tracy,California E.N.9 2M 1.67 Vanguard Press