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FOR OFFICE USE: r------- --- -----�a- -- APPLICATION' FOR-SANITATION PERMIT Permit No. _�� -------------------- ' �. M-. (Complete in Duplicate) Date Issued ------------------------------ .------_--.---_.- j 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 LOCATION-------- ----------•-- ----------------------------------------- ' 1 Owner's Name p "Q ---- 1 6Eo e--------------------- CC Address > �rS-- ` r ------------ ----•--------------------------------------------- - ---•---------- a Contractor's Name--.--- -•- -•------------------------------- ----- Phone--------------------•-------------- Installation will serve: Residence PR' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` r Number of living units: J---- Number of bedrooms ___?_ Number of baths A---- Lot size -- - ..Ld=-O---------------------------------- Water Supply: Public,system [[rCommunity system ❑ Private ❑ Depth to Water Table-$-A ft. Character of soil to a depth of 3 feet}: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: {If yes,ldate--------------------) No �New`Construction: Yes 5I�o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----_—_-_---Distance from foundation-_---/_D- ......Material......-- r $-`,�---------- No. O of compartments- 2- .__---_---.-.Size----- ' -� �� --Liquid depth----'� -------------.-Capacity--- ._. -------�-� Disposal Field: Distance from nearest well---- ---------Distance from foundation--IA?.............Distance to nearest lot line-NP- �.----. Number of lines-----A..------------------------Length, of each line--.-_7,X................Width offrench---p21,- ----..--..------_- r Type of filter material_'_?&L/(-.----___Depth of filter material..../-$...........Total length--- ;,A4Z0----------------__----_ Seepage Pit: Distance to nearest well.---------------Distance from foundation-fid_.-----.--Distance to nearest lot line-----4.!- Number of pits-_x&--------------Lining material--- I Diameter____- ----Depth-..v2rj_-_�_- r ------------ �] Cesspool: Distance from nearest well- --------------Distance from foundation--------------------Lining material-------------------.--..---.---------. Diameter - --- - -------0--- ----------De th----------------------- ---------------- ------ ---Liquid Capacity. gals. r Privy: Distance from nearest well------------------ - Distance from nearest building----------------------- - g------------------------------------------ Distanceto nearest lot line--------------------------------- ------------------------------------- ------ -----•--- ------------------------------------------- • , c i Remodelin and/or repairing (describe): I ------------------------------------- ----------------- -------------------------=--------•-------------------------------------------------------------------------------------------------------- ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws nd rules and gu qothe San Joaquin Local Health District. - = --- -- ------ = -------- By: ---------------------------------------------- --....Owner and/or Contractor (Signed)---------=----- { 13 :-------------------------------------------------------------------- Tale y� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY 1 T APPLICATION ACCEPTED BY . -=----- --- ---- ----------------- ---------------------------------------• DATE... -e0 - REVIEWEDBY----- ------------------------------'--------- ------------ ---------- ------------------------------------------------------- DATE------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------- ---- ---- ---------------------------------------------- --------- DATE------------------------------- --------------------------- I Alterations and/or recommendations:- :. _0 -.-fJ_ �--L-- ---- - ------------------ �.- �" --..1- == - ----�---- -- •------ -- --- -•----------- ----- ---- --------------------------------------------------------- ------ -�--------------------------------------- ----------------------- ------------------------------------ ------------------------------•--- ► 11 FINAL;INSPEQTION BY:-CJ�..`.. Date- ------ --- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockton,California Lodi, California Manteca,California Tracy,California I F.P.C13.