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rVK 1, NI ! u�)t: ------------------------------------------------------ ------------------------------- ------------ --------- APPLICATION. FOR SANITATION PERMIT Permit No. 1 ------- ------------ -------------- ------------ ------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued -_- t 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. 544. I€ JOB ADDRESS#AND CATiO ---G�,�G ----- ----- , e} ------------- Owner's2- Name.t _ --- -�------------- --------- r ------------- ------- � - ----- --- ------ Phone Address------------ -- - + _ ----- --- - ------ Contractor's Name... F - _ = --------- ----- ----- -- hone ------�--•-- - - - --------•-------- Installation will serve: Residence dApartmerif House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units, _... _ Number of bedrooms__ Number f baths I____ Lot size Water Supply: Public system ❑ I ommunity system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [-] Clay Loam E] Clay ❑ Adobe E-] Hardpan Previous Application Made (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ 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--------------------Material -__-..__--------------------------- 1 ❑ No. of compartments Size -----------Li Liquid de th---- ----------- ------- q R Capacity_---- ------------- L,0 Disposal Field:) Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-_-.--____.-.___ ❑ } Number of lines- --------------------------------Length of each line--------------------- ------.Width of trench Type of filter material-------_----------------Depth of filter material_--.------------------Total length----------------- ----`S� Seepag .Pit; i Distance to nearest well._._lCp...._.....Distance fro foundation.-.•!f:>..`__!----.Distance to nearest lot line-_---.5 '_-v' Number,of:pits--- __._I-----------Lining material._ . ` _-----_-Size: Diameter-.... Dth ep Zoe ` ._. ------------------- -- Cesspool: Distance from nearest well-----------------Distance from foundation.___----------------Lining material-----------------.-------------------- ❑ r Size: Diameter--- q---------------- -- Depfih------•---------------------_-- Li uid Capacity 1 - q ------------------- Privy; ---------gals. Distance from nearest well._:r- - ------- --------------------_ ___..___Distance from nearest building._______________________ ❑ . ._. / i Distance to.nearest lot line----------------------- Remodeling and/or repairing (describe):--------- ----------------- -=- -- ---- --- - -- --------------------------- r ------------------- ----- -- --- -:---------------------------------------------------------------------------------------------------------------------- --- ' 1 � i Y prepared - , i 1 - ----------------------- ------------------------------------ -11I herebycertify that I have re pared this application and that the work will be done in accordance with San Joaquin County ordinances; Sfa ws, and rules a regulations of the San Joaquin Local Health District. # i (Signed)----- --------- Y� .- --------- - ------------------- ---------------------------------------------------------------------- ---------- � - •yam• - and/or Contractar ��.... .R.. `B .�'.�`''7 , r -- - rifle'---- - ) ; (Plot plan, showing size of lot, location of system ig relation to wells, buildings, etc., can be placed on reverse side). k i # FOR DEPARTMENT USE ONLY -------------------------- APPLICATION ACCEPTED BY- REVIEWED Y VIEWED BY ----------------- DATE- - ----- ------- - --------------- --------------- -------- BUILDING PERMIT ISSUED------------------------------------------------------- , - DATE -------------- d Alterations an /or recommendations: ------------------ ---------------------------------------------------------------------------------------------------------------------------------- t # ---`- r ------------- ---------- ------ ------ ------------------- ------- =--- I-------------- � _ 1 ------ i ---------------------V---------------- --------- --------- ---- r FINAL INSPECTION BY:..-. ---- --- -- ---------- _ _ -- ----- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street _ r 124 Sycamore Street 205 West 9th Street Storekton,California Lodi,California Manteca,California Tracy,California