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FC> t OFFICE USE: " - -------------------- No. 70. _ _ APPLICATION FOR SANITATION PERMIT Permit .. .......... --- - -------------- --------------------- - (Complete in Duplicate) � ? This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. •- : 7�S-a�U-lam This application is made in compliance with County Ordinance :No. 549. E_ SI Di- C341 ^ / ` l ' JOB ADDRESS AND LOCAT ON.._��QL Ir�� r p � _- C�- /7L1_�Y r --FF_FD--j-------/-0r v0_�-1------------------------------------------ ------------------------- '-------/ Phone Owners Name.___ k ' Y Address--------- O -�SCf�_LG 1�----------------------------- ---------- ------•---•----•-------------•----.----------- .. r Contractor's Name-----__0_VVN 5U�--------------------------------------------------------------- ----------------------------------------------- Phone--------------------•-------------- Installation will serve: Residence Apartment House ❑ Commercialp0 Trailer Court E] Motel ❑ Other ❑ f Number of living units: /-__ -- Number of bedrooms 3-__ Number of baths -1-.- Lot size _ C[ �7 ----------------------- t 1 Water Supply: Public system%-❑ Community system ❑ Private Depth to Water Table 957ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0--Clay.toam ❑ Clay ❑ Adobe ❑ Hardpan ©� Previous Application Made: {If yes,date--------------------) No 2}'New Construction: Yes ❑ No [2j----rHA/VA: Yes ❑ No�-� TYPE-OF INSTALLATION ANR SPECIFICATlON5: (No septic tank or cesspool permitted if public sewer is availa0e within 200 feet.) Septic Tl Not well—_-� __-D ance fromfoundmation------------•-------Materi.al--`---=-- ------------------------------•---. artmens-- - --- - d ...... ---------Capacity----_-.----.----_-_._--of com B Disposal Field: Disfance from nearest weld.-J�0..._Distance from foundation---.-/ :_-_.Distance to nearest lot line------ l Tl4Gr- Number of lines------ _____1_ f..---Length of each line---_��._.-' �Width of trench______-��..._��__ " p p Type of filter mate r"ja!__g-V G \-----Depth of filter material_--_-� f.- - ... otal length----_---_S. -__-`----------------- I Seepage Pit: Distance to nearest;well___,lA0-A9!-----Distance,from foundation_____&2_____.Distance to nearest lot line... t r [� Number of pits------- -------- -Lining,mamaterial-- . l--h0� ---.Size: Diameter:_l�i_x--_Z -------Deptn--. .------------------------- Cesspool: Distance from nearest well-----------------D_.istanc&from foundation____.______------------ _Lining material__--_-_-.---_______..__.____________. ❑ Size: Diameter. €--------- tDepth`--- -------------------------------- ------- ---I LUquid Capacity-_------------------------gals. Privy: Distance from nearest well------------------- ------f-------------.--Distance from ne est building-----------------_------------------------ 0 f ❑ Distance to nearest,Iot line--------------------------------- -- --------------------- - -----------!--i------------------ ---------- ------------ ------------ } Remodelingand/or repairing (describe):-------- ------------------------------------------------------------------------------------------- --------------------------------------------• 5 --------------------------------------------------------------•---------------------------------------------------------------------------------------------------------- ----------------------------------------------- .. --------- ---------------------- ------'---------------------------------------------------------------------------------------------------- �-•---- -- j -------------------------------------------------------------------------------------------------------------------------------=------------- ------ - ;------------------r-------------------------------------- I hereby certify that I have prepared this application and that the work will be done accordance with San Joaquin County ordinances, Stet laws, a`nd rull and regulations of the San Joaquin Local Health District, -------- ------ - ------------------- --- -------------- Owner and/or or) L (Signed)= - -e7. - - ( - - . T - � Contract By:---------------- ----------------------_- ---------- -----------------------------------------:-----------------�Titl�---------------- ---------- --- ................................ -h r (Plot plan, showing size of lot, location of system in relation to wells, buildings,tetc.,'- w , 'e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -------- -------------------------------------------- ------- ---------- DATE----- -- s Cl. ---- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------.------------------ ---------------------------------- r BUILDING,PERMIT ISSUED----------------------------------------------------------------------------------- DATE - �! I Alterations and/or recommendations:-- ------------- ----------- - ---------------------------------------------- - ---------------•------.----------------....---------------------------- v - ----------------------=--------- ------------ -------------_---------------------------------- -------------------------------------------------- ---------- FINAL INSPEC BY: Date ---------------------� --------- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 5tacklon,California Lodi,California Manteca,California Tracy,California F.P.Cd.