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R OFFICE USE: , 3 r 3 APPLICATION AOR SANITATION PERMIT Permit No. ..l._- 1 C_-_ -------- ------------- -------- -- -- -- r y ----------------------------------------------- - (Complete in Duplicate) / / b --.--------------------------______________________.--- This Permit_Expires 1 Year From Date issued 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 fiiacle/in compliance with County Ordinance 549. JOB ADDRESS 4.AND ' CAT10N... .� _ '__ ------- Owner's Name_ - 6R ------------------------------------ ---•-••-------------- ----------- --------------------- ' --------------- Phone Phone-------------------------•-•-------- . Ll Address-------"- - - --- -��--------------------------------------------------- -�L-� ---------• --•------------- Contractor's Name --- -------------- -•----------------- Phone-------•--------•------------------ Installation will serve: VResidence`ga- impartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ - Number of bedrooms -2or Number of baths _/--- Lot size._ "_. _________-_-_--____.______ Water Supply: Public systern,�VCommunity system ❑ private ❑ Depth to Water Table 40vft f?1 k�/ YJ,-! Character of soil to a depth of 3,feet: 'Sand ❑ Gravel [—] Sandy Loam El Clay Loam ❑ Clay E3 Adobe fardpan C3Previous Application Made: -(1?-yes,dcite_"�',-----iv----`.-__) No New Construction: Yes ❑ No 5a,-FHA/VA: Yes ❑ No 21, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if'publi sewer is available within 200 feet.) S 2,{'ic Ttnk: o Distance from nearest well---- ;---____r-Distance from foundation--------------------Material--------------------------------------_---__._. No. of compartments---- - ---------N------Size------------ ---Liquid depth--------------------------Capacity------ ---------------- Disposal Field: Distance from nearest well--.-------\__Distance from foundation--------------------Distance to nearest lot line_________________ Number of dines--------------------------------\.Length of each line------------------------------Width of french.------------ _---------- Type.of.filter_ma.terial_________________________Depth of filter material------------------------ length-------------------------------__________- i ) f Or7�_ eXPi : Distance to nearest well-.._" ""..____Distance fir fo dation_____ .___Distance to nearest lot line__. Linin rnateriai__ �_ Slze: Diameter__ _ Number of pits-------�---------- g - � ��------.Depth_-2��_ _ _^ Cesspool: Distance from nearest well----------------- from foundation_------------------Lining material-------------------------------------- (11 ) Cl Size: Diameter--------------------------- ----- ----Depth------------------------------------------ --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------- -- -----'-,____ _M. .=Distance from nearest.building---_--____--_-___________________..____._. ❑ Distance to nearest lot line----- �------------------------------------------------------------------------------- ---- --------- IS Remodeling and/or repairing {descrik�el:------- ---- - •----- /f r I ----=----------------- --- -- ---- ------------------------------------------ ----`--=---------------------------------------------------• ------•---- - ----- 1 ------------------------ ------------- ------------------1-----•---------------------------------------------------------------------- ------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule .and regulations f the San Joaquin Local Heal#h,District. - ------------------------ ontractor) (Signed) --- --------- - BY Title r ------------ (Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can(be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- + A -- ----------------- ----------------•-- ------ DATE- 1 -'-----1 --------------------- REVIEWED BY-------------------------------------- ----------------------------------- - ----------------- DATE-------------------- --------------------------------------- BUILDINGPERMIT ISSUED---------------_---------------------------------------_ - DATE------------------------------------------------------•------ Alterations and/or recommendations:__1_Z_'._r_ _'__._�e I_._.-----1- k Sk�-- -.'.:-.- I i mss, ---------------- �. --- = � 5---------------------------------- ---------- ----------------------- --------------------------------------- -------•------------------------------------------ t --------------------------------------- ----- FINAL INSPECTION BY:_.--Cs- - ------ -------- ----------------------- Date--- -Z-' 1 - 3------------- 4 SAN,JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300'West-Oak Street 3224 Sycamoreistreet 205 We t 9th Street Stocktan,California Lodi,California Manteca,California Tracy,"alifornia CS 9 DEVISED a-S9.3M 3-'63 F,RCD. 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