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FOR OFFICE USE: ------------------------------- - --------------------------------- -- _-.._ _ _. ---- APPLICATION FOR SANITATION PERMIT Permit No. ------ ---- ---------------- ---------------- --------- {Complete-in Duplicate) ............. --------- -- - --------.. -- This permit Expires I Year From Date Issued bete Issued -� -� - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the k herein described. This application is made in compliance with County Ordinance No. 549. E Z f� 3 J08 ADDRESS AND LOCATION.- -.--�1 ,,/_C7r7p,� Owner's Name--- {_-- /i / f-3-/-s� o/ --------- ------ - ---- Phone'7!------:72FyC `1 - fff��s1 ------------ Contractor's Name- �_.`,__ A Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- ----- Number of bedroom.- Number of baths-r-----Cot 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: (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 .-___....-.-__---.-_------ ❑ No. of compartments-- ----------------- ----Size----- ---------- -----------Liquid depth--------- - ----- -- Capacity ` Disposal Field: Distance from nearest well- ...........Distance from foundation---------------- Distance to nearest lot line--------- ❑ Number of lines ---------------------------j`---Length of each line--------------------------- Width of french -------- Type of filter material............... ---D" fh of filter material_-.------_--_._____Total length._------- ___---_-._-_-.__-________-_ Seepage Pit: Distance to nearest well------ ._._,:__=D`istance from foundation--------------------Distance to nearest lot line--.--__---.---.._ ❑ Number of pits--------._----------Lining material---- Size: Diameter. - Depth ---------- Cesspool: Distance from nearest well ---------------!Distance from foundation--- ------------- --Lining material-..__-------------___---------_--.140 ❑ Size: Diameter- -- --------- ---- --------------!Depth-------------------------- ----------------------- Liquid Capacity------ ---gals. l Privy: Distance from nearest well-------- ------ ----------------_____Distance from nearest building------------------------------------------ # ❑ Distance to nearest lot line __---._...f Remode'ng an r rep ' ' g (describe):------ _.--- r ----- ----------------------------------------------- I �A;_ --_ �� - - �------ ------ I hereby certify that I ha prepar this application and tha he wor ill done in a dance with San Joaquin Count ordinances, State I nd rule nd r gulatio s f the n o uin Local alth i .._ o E (Signed) --- ---------- ---- Q�Contractor) , y:------------------------------- --------------------------- -------------------------- - Title ------------------- -- (Pl ot plan, s owing size of lot, location of system in relation to a Is, buildings, c., can be placed on reverse side). 1 � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �.-..� REVIEWED -- -- - -- DATE - -� ------------------------ BUILDING ------------ -------- I DIN PERMIT ISSUED ----------------------- ------------------ ----------------• DATE-_. -------------------------. -. -- ----------------- )I -------------------------------------------------------- ..- DATE.------------------------ A terations and/or recommendations:.......................... --------------- ------ - - ------------------- ---------------------------------------- *__ ------------------------------------------------- ----------------- ------------------------------ ---- ----- --- ---------------------------- r FINAL INSPECTION BY:..---- - r. _.- - Date-------------- -` 5r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5lockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press