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OR OFFICE USE: ..~�t �s ------------ 1/ d ti V APPLICATION FOR SANITATION PERMIT Permit No. .. -------------------------------------- --------------- ------------ --------- Duplicate)------------- -- ------------ (Complete in - � bate Issued -.-_---------------------------- _- 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. JOB ADDRESS AND q LOCATION....-.'f .....9 -------------------- ----------------------------------------------------------- ----------------------------- Owner's Name_.--(./ --. !f/ ------------------------------------------- - -------------• -------------------------------------- Phone Address----------a-Z-7-1----0......... --------------------•------------------------i ----------- ------------------------------------------ . Contractor's Name------ ------ ---------------------------------- { -• ----.. Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court .❑] Motel ❑ Other ❑ Number of living units:---1-.. Number of bedrooms J--- Number of baths _ --- Lot size !a_ ~D.`---------------------------- Water Supply: Public system B'Community system ❑ Private ❑ Depth to Water Table -6- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel E❑ Sandy'Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er—Hardpan ❑ Previous Application Made: (If yes,date---------------_---) No New Construction: Yes �o ❑ FNA/VA: Yes ❑ No [-� 31 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) I -------_Distance from foundation----/4Z------.Material----� '�'-`7__------------ No. ---- -. Septic Tenk: Distance from nearest well - - [r No. of compartments-...-�--------------Size-----3- -cS-X-9-1---- Liquid depth------1�----------------Capacity..d'dQ - Disposal Field: Distance from nearest well.—.-.- -. ------Distance from foundation---/0---F--------Distance to nearest lot line---- Number of lines--!---------------------------Length of each line--_7sz=--- --___-___._.Width of trench- _2. ---------------------- Type of filter mate71rial-_' 42-4-�-____Depth of filter material--/e__'-_------.Total length.......U-:v------------------------_. Seepage Pit: Distance to nearest well--_--r_.__------Distance from foundation_------D--r--.---.Distan-ce to nearest lot li ne----] ------- Dumber of pIts.-- _--------------Lining mateaL--- C� �.-.Size: Diameter-----�-�- ------Depth---- s�-J -i------------ Cesspool: �. Distance from nearest well-----------------Distance from foundation---.----------------Lining material----.-.------------------------------. 6' ❑ Size: Diameter------ -------------------------- Depth----------------------- -----------------------Liquid Capacity----------------------------gals. > I Privy: Distance from nearest well-----_------------------------------------ ---Distance from nearest building-------------------------------:---- ❑ Distance to nearest lot line-__._.__----.-.-- '"• ' -------------------------------------------------------------------------------------------------------- L Remodeling and/or repairing (describ.e)=---------------------'------------------- -------------------------------•--------------------------------------------------- _---------------• , -------------------•------------------------------------------------- ---------------------------------------------------------------------------------------- ---------=----------------------------------------- - - ------------------------------------------------------- ------------- ----------------- --- --------- ------------------------------------ --------•-------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,✓and rules a d regulations of the San Joaquin Local Health District. (Signed)----_---_.-- `---- ----------- --------------------- --------- .----- - --------------------------- - ------------------------(Owner and/or Contractor) , �. _ . _ Title $y= ---------------------------------------- -------------------------- ( ] - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----6.......` --------- ------- ----- -------- ----------- ------------ DATE. 72,2_3_.-(O__5-------------------------------- REVIEWED 2,-'-3 (OS'------------------------------- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------ ---------------------------------- BUILDING PERMIT ISSUED------------------------------------------------- -------- - T ---------- DATE---------------------------------------------------- - - ---------- ---- Alterations and/or recommend tions:_-,5-t--/� � ----- Y1- -- --- ---__- ---- 2.. -t-- ------------------------------- -----------------------------------------------------------------I----------------------------------------------------- -------------------------------------------------------------- ------------------------- ------- ----- ------------------------------- -------------------------------------------------- --- ---------------------------- - ------------------------------------- ---- ------------------------------- - ---------------------------- ------------- ------------------------------------------------------- FINAL INSPECTIONBY: = ------------ ------------ Date---- -�' !.... ) �- _5 (Q --- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocktan,California Lodi,California Manteca,California Tracy,California F.P•C D. ��.. v - 1 T ' ..