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'�/FOR OFUSE. "� r' a APPLICATIO`i FOR SANITATION PERMIT Permit No. l��.a--�----•- (Complete in Duplicate) Date Issued - - ---------- ----------------------------- -------- This Permit Expires 1 Year From Date Issue 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. �, P' i-- -------------- I JOB ADDRESS AND LOCATION C -/-..- ..' i �✓/ --- ----- Phon .. - -: - -_/1- Owner's Name--------- f .1 - -------- �/ �_ -- --------- --------------------------------- Address---------------------- -- --- - •------- - ---�---- --- one �zQ- •--------- Mo -fir P h � Contractor's Name----- - ---- Installation -- • - .L_'n �r r Installation will serve: Residence gK Apartment House ❑ Commercial ❑ Trailer Court ❑ tel ❑ Other ❑ Number of living units: --_L_ Number of bedrooms ---'Number of baths _I_--- Lot size -__-----1-d Water Supply: Public system � Community system ❑ Private ❑ Depth to Water Table .-.--_- ft. ------------- I Private Character of soil to a depth of 3 feet: Sand ❑ Gravel F71Sandy Loam [IClay Loam ❑ Clay N Adobe ❑ Hardpan 0 Previous Application Made: (If yes,date--------------------) No R New Construction: Yes ❑ No LX 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- -LP-_---. Materia!_..-__-----._._.__ ---- ----- � 9 Li uid de th--_,- - Capacity..®---- - tt No. of compartments----- -�-`- ------Size--�'=,X-l�--- �- ----- q P -- - k p Brest well-----------------Distance from foundation------1[9--"_.Distance to nearest lot line--__ ----------- Disposal --~_�-_- Dis osal Field: Number of lines e from . Length of each line /'�� -.Width of trench. --�-�------- ------ JJ f <� Type of filter material-___S� �j Depth of filter material---_� ---- ----Total length------- ------------------------- Q Seepage Pit: Distance to nearest well____.................Distance fr foundation--_ eP---------.Distance to nearest lot line----- -.---- Number of pits------1--------------Lining material__W_4_�/��-- Size: Diameter,- --.n---�a}Deapth_= 5 - VIA Cesspool: Distance from nearest well-----------------Distance from foundation___.__- .._-..-_Lmi g gals-' ❑ ------Liquid Capacity------------------- 9 Size: Diameter-.--=------------- ---------- Dept h --------------Distance from nearest building1 Privy: Distance from nearest well-------- ----•----- - -=------ ------------ ---- ----- -� �! Distance to nearest lot line---------------------------------- ------------------------------------ ---- r Remodeling a d/or repairin E scr,ibe):--.�--. � .� = ray �y•r !1� ,F:Y �' 7 -_ ---------- ------------- _ -uin L tions of the San Joaquin- regulations q 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State d rules and g ocai Health District. �7' -f7_.-- �/ '----------------------- ----------------------- [ r and/or Contract- _ Ow d/o or} [Signed) Iate,- ---------- ----------------------- -------- {Title} L.r - . ----- ---..._..... By:--------------' [Plot plan, showing size of lot, location system in relation to wells, buildings, a+c., can be placed on reverse side}. FOR DEPARTMENT USE ONLY iAPPLICATION ACCEPTED BY. 0-1 t- ------------------------- ---------------------------------------- DATE---I-I-- -------- --------------------- REVIEWED BY---------------------------------- BUILDING PERMIT ISSUED-------------------------------------- --------------------=–---------------- }� R Alterations and/or recommendations:._-1-1 i.-?--- .---(e-- ----- --- ------ �►-•--------- { - - - --------- ---- Ca-�- ------------ ---- ---------------------------------------- -- - - ------------------------------------------ ---------- ------ i.,,.- - ----------------------------------------- -------- t ------- Date- ll-'��.�-- --- -------------- --- --------------------------------- FINAL INSPECTION BY:..._C._.�.- SAN JOAQUIN LOCAL HEALTH DISTRICT s 1401 E.Ha:eltan Ave. a 300 west oak street 124 sycamore Street 205 West 9th Street 5toektan,California Lodi,California Manteca,California Tracy,California