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FOR OFFICE USE: r Q r ------------- -------------------------------- �._ APPLICATION FOR SANITATION PERMIT Permit No. -------------------- --------------------------------------- (Complete in Duplicate) Date Issued 44 --------------------------- --------- 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 rrjaqe in compliance w'th County Ordinance No. 519.. .ZY7- l C-0 -oy <:Z.& 5-14 e_,�-a Nts` pp , t r JOB ADDRESS AND OCA�TION________4N .-----------Lo_________.�1 - __--____. _.__ [_ !_._. sc Is _ --- - ] - ----._. Pho _ �`�C ....................... f_9__ d1`J�S1I�� -------------------- Address . ........................... --------- -- -- i IContractors Name------ ---------------------=--------------------- ---------- •----------------------- Phone----..-.----------------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----(_._ Number of bedrooms _1-Number of baths ---f--- Lot size --------AGRF-A.6 _____________________ ' Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _25 ft. Character of soil to a depth of 3 feet: Sand [EGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (H yes,date---__.------------ -) No Er-_-New Construction: Yes ❑ No FHA/VA: Yes [❑ No.�� TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic�Tank: Distance`from nearest welf!"5��[3isfance from -pj4& - No. of compartments----_ . // .__.__..Size-3.6_-_.'_________ _________Liquid de th._.____ .. Capacity -5 00 + Dn f q P. �--------------- P Y 1 i Disposal field: Distance from nearest well_! o__°Distance from foundation_ _______ ________Distance to nearest lot line____________-__ cs- Number of lines___________`. Length of each line'______ _.i __�._ _ Width of trench------- 1� h Type of filter material----J�O_CK__Depth of filter material------V/__... Total length________.._______________�O_"_�--------- j Seepage Pit: Distance4o nearest well----------------___---Distance from foundation--------------------.Distance to nearest lot line-----_--------- `tl�F '.❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------___Depth- ----------------------..------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._.___----___.____.-_____._________ ❑ Size: Diameter------------------------------------ Depth----------------- ----------------------------------Liquid Capacity----------------------------gals. o Privy: Distance from nearest well-----___-------------------------_---------------Distance from nearest building________________._._____________.____..._. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-----.�0WK.--_t4N1)?-----i-F-f_}C-1.4------F-0P1 -Av7vf ,+,-1C-------w�`aH1�1r—=-- . 0N1=,V---`--------M.A-,P ------ -1_FPi 1Wq -_. ----------------�1_l ----- -------------------------------- --- -- i ------------------- -----------------------------------=--------------------------------------------------------------------------------------------------- --------------------------- ------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance`, State laws, and rupees and regulations of the San Joaquin Local Health District. i1A-- - ��- - ------ ----- - _---...-.(Owner and/or Contractor) (Signed)___ _ _ ---------------------- By:-------------------------------------------- - ------------------------------------------------------------------------ ------(Title)------- ------------ -------- ------ ----- ----- ---------- L_ '[Plot�'plan, showing size of lot,16cation cf system in relafion-to=wells;buildings;etc.;can,6e-placed--on,reverse..sid e). r- � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ---------- ----------------- -------------------------------------- DATE- -~ ------ ' REVIEWED BY----- - =--------------------- -- ------------------ ------- ----- ------ DATE-------------------- - BUILDINGPERMIT ISSUED------------------------------------------------------------------------ -------- -------------,-- DATE------------------------------------------------------------ Alterations --------------- ---------------- Alterationsand/or recommendations--- --- --- ---------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- - -------- _...__. - h . .___ _____ _____ ___ -----------__________ - �._ � FINAL INSPECT-CON B ---- Date------------ - --------- ---------- - -- ----- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocktonr California Lodi,California Manteca, California Tracy,California t • F.P.CC. �t