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APPLICATION FOR SANITATION PERMIT Permit No. --_---�_1..�__ (Complete in Duplicate) 7� Date Issued -----_-1G----------- 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,1County Ordinance No. 549. � JOB ADDRESS AND OCATION-____ —,f -.�` `S-r ` 1 --------- --- -------- - ---------------------------------------------------- P - ----------- ---------------- __f -------- Owner's Name--------- -- --L --------- --------------------------- ------------------------ ---------- ---------------- one- --------_-_C1---4!7c Address-------- r� 1 `sl_. �-� ------Jr ------------- i Contractor's Name---------, �- ------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_-_-_ er of bedrooms:74-- Number of baths 9:7 Lot size -----------------------__--._-----_---_---__---__----- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand /Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes �Q AVO E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic C Distance from nearest well--ZlW_._.Distance from foundation .Material__________________________ q Capacity--- X_ apaci f_ No. of compartments---.-...-- Size- --------------- �__._ _Liquid de th--his#ante to nearestJO i Disposal e d: Distance from nearest well. ------ Distance from foundation--- -._----- 1 ----_ Number of lines--3--------- ----------------Length of each line�0-_47-3 _�J20__.Widfh of trench_.--------------- -- Type of filter material---_ _____Depth of filter material__---/ --____.__-Total length---,6'�------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- F] . Number of pits----------------------Lining material-----------------------Size: Diameter----------------------_Depth--------------------------------- (ni Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--__-----._.---.____.____-.---_-_--_ `• ❑ Size: Diameter--------------------------------------Dep h----------------------------------------------------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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------------------------------- ---------------------------------(Owner and/or Contractor) By:------------------------------------ - -----------------------------------------(Tifle)---------------------------------- ------ -------------------------- - - - `• - ------ --------------------------------------------- ----------- ------------(Piot 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 ------------------- --- DATE ----- REVIEWEDBY--------------------------------- ---- -- ------------------------------------------------------- DATE---------------- ---- BUILDING PERMIT ISSUED---•--------------------- -- ---------------•--------------------------------------- DATE----------- -1r Alterations and/or recommendations:----- -- - - - --------------- ----- ------------------------------------------- -- --- -----------------------------------:----- -------------- - --------------------•---------------------------------- ---------- -- -- -------------- r�+Jr F 4�� 4 0= �=1 / t -- .C�x r � ---------- U_V11 ;.� ------- L�{� - -- ------- �-AA_ ----4-ee L"Z-.g-- 4-------------------------------- ------- FINAL INSPECTION BY:--- - ------------------ Date------- - --------------------------------------------- SAN - ------------------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Sfocktcn, California (Lodi, California Manteca, California Tracy, California E5-9-2M Revised ;-57 F.P.CO- f