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FOR OFFICE USE: C f7 3 83 -------------''-...-..------------_------------------'- r- d -----------------------------_.__-.------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------ -- --- r. (Complefe•in Duplicate) Date Issued ------------------ - ... .........._.------_-__.-_-_-._-- ., 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. 3 _ 12o-0 (��o r tE[6u�o4 y y rs1,r^ JOB ADDRESS AND O TIO�X 6�. `' ------- <= r./.Ill�,•!Y�r C � � � w Owner's Name-- ___.--_-_- X1 7._--_-__� ... Phone___- Address------------------------------------ __._ --- ------ �- Contractor's Name--------- ------- --- -------- ------ --------------------------------------------- Phone . `��^{ •� Installation will serve: Residence D� Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms _L Number of baths—?__-_ Lot size ----- -_�_,j ----------------------- Water Supply: Public system ❑ Community system ❑ Private P< Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,d Hardpan ❑ Previous Application Made: (If yes,date___,Y Sj'YI No ❑f 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---�w.. Distance from foundation.-.l4-1 Material -e = . Q/ �I-Lu1 No, of compartments_-__-----2..�-____----_-Size---- a'�� -.___Liquid depth----- .. �j`®�Ca acity___-/-4� - r � Disposal Field: Distance from nearest well-3—J----Distance from foundation.. <f7-1--pistance to nearest lot line___�_ A�--�'"-j Number of lines---_______p'��._..-. _ _ Lenvh of each line-- -----------$---719--Width of trench--___---;n_ .. Type or filter mate 1 -5-__ .__.- _-__ ept of filter material___/---_ ------Total length---- - ---------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation_____________:__-_.Distance to nearest lot line---____-_____---_ ❑ Number of pts--- ------------------Lining material---------------------- Size: Diameter-----------------------Dept h--------------------------------- Cesspool: Distance from nearest well ________________Distance from foundation- - -.----------- - Lining material------------------------------------- El Size: Diameter- -- --------- ----- ----------------Depth------ -------------------------------------------Liquid Capacity__----------------------gals. Privy: Distance from nearest-well-------------------------------------------------Distance from nearest building.----------------------------------------. ❑ Distance to nearest lot line ---------------------------------------------•-------------------------------------------------- -------- ----------------------------------- Remodeling and/or repairing (describe)=-- -------------- ------------------ - - '•-------------------------------------------------- -------- ------------------------------•---------------- ------------------------------------------------------------------------------• -------------------•------------------------------------------------------------------------------------------------------------------------ --------------------------- --------------•--------------------------------------------------------------------------------•--------------------------------------------------- ------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S-fe lards, and rules n regulations oft &SaJoaquin Local Health District. _ J (Signed)5Z_- `" - -- -------------------------------- ------ ...............(Owner and/or Contractor) By:-------------------------------- ----------'•---- ----- ---------- - --------------- --- ----------------------.................(Title)--------- -------------- ----- ....... . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - !r�'� ------ DATE-----,-C�------ ------- REVIEWED BY---------------------"-------------- - - - ------------------- DATE--- -_-_ -- ----•-• - - -- - - -------------- ----- ------------ - BUILDING PERMIT ISSUED-------- -- ------------------------------------------------------------------- ----------- ----- DATE-----"------------------- - - - ----------------------------- Alterations and/or recommendations:--'------- ------------ -- --------------------------------------------------------------------•-I--•-•-------•---------------I--------------'--•-------------- --------------- ------------------- ------------------------------------ --- ----------•---------------- -------------•---------------------------------- ---------- --------- ---- --- ------ ------------------- --------------------------------------------- ----------------------------------------- -----' --- ---- ---------------------------- FINAL INSPECTION BY:-.6/44-- ---------------------------- Date--'-- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press