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FOR OFFICE USE: ------------- - /�:°o_-�-. APPLICATION FOR SANITATION PERMIT Permlt No. .._.. - y I ' ----------------------------------- -- (Complete in Duplicate) Date ------------------- _ Ilssued __C _ - -------------- This Permit Expires 1 Year from Date Issued I 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 f? I '{ JOB ADDRESS AND LOCATION - *= -� ------------------------------- �} yy} Q / ��-y----------1-7e Phone---------- Name--------------.—�___�t '---r--'---1 e! �<=1 l4� �`J � —�{ -- j I -------------------------- Address----------_---- A'.0_6------------ Contractor's Name-------- A'.0._ . - ----------------------------------------------------------------- PhoneM ..-.. Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --! -f mber of bedrooms _?__ Number of baths -I__ Lot size __ -_ J- ----' ----------------- E Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 6-o'- ft. Character of soil to a depth of 3 feet: Sand ❑ F1Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ �.,�� I Previous Application Made: (If yes;date-------------------) No [ New Construction; Yes j? t-o ❑ FHA VA., Yes ❑ No � r TYPE OF,INSTALL--ATION AND SPECIFICATIONS: (No`septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well_- — Distance_from foundation--/e._/------ terial---F—i----_�-------- --�-.-----. ____. Ca acit - �--.- No. of compareents. f Size q P. /Z I` p _ Disposal Field: Distance from neares well._.__..--.--.--.Dista from �� oundation----�.0__`--.f....Distance to nearest lot line--�..__�_. E P ! [� Number of lines----____ ---- Length of each line____ __ ___________________Width n trench. -r-.-.-- -!j-.- .. ) - (l Total ken th �M - -r------------------------ > Type of filter materlaL- /. ,_ __---Depth of filter material----� i --.-- g I --- Seepa it: Distance•to nearest well------- ------ ------Distance f om foundation----1__ -.�---Distance to nearest lot li --: � UJ Y P Number of its'_._-_ ----__Lining material-- -------Size: Diamieter---9.2--.�_.---De"pth___s�., _-_--rv'/------. 40111110 Cesspool: Distance from nearest well-----------------Distance from foundation-----._.,._-------- Lining materiahl--_.__......------------__---._----- Siae: Diameter - ---------- Depth----------------------------- -- ❑ -Liquid Capacity-------------------- gals. k Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-I---_----._.___________--------------- 3 ❑ Distance to nearesf lot line------------------ ----------- ---------------------------- ------.:--------- Remodeling and/or repairing descri e -- �------------ (__r- -----------------•---------------- -_=- --------------------------------------- i ;j ---ii--------- ----------------------- ----- -- -----------------------------------------------------------f-------------------------------------------------------------------------------------------------- ----:--------------!M-------------------------- ----------- I hereby certify that I have prepared}+hislapplication and that the work will be done in accordance with San JoaquinCounty ordinances, State la ' rul s and r tions of the San Joaquin Local Health District. (Signed) '�_ - (Owner and/or Contractor) � - -----(Title)---; -.�f I �.. ----------- -------- --- -- - ---- -------- (Plot plan, showing size of lot, locati n system in relation to wets, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �l APPLICATION ACCEPTED BY- - - -------- - DATE 1a 11- r�'�i� REVIEWED BY - -- --- - ---------------- --- ------------------ DATE i BUILDING PERMIT ISSUED----------------------- ----- -- -----• --••-------------------------------------• DATE------------------- --�------------------------ ---- --------- - Alterations and/or recommendations:---,4 �i��----- � y - _ -sc�,. �lPlf ..- �� , ---------------- -------------- --------------------------•-------- ll -------------------------------•-----------------------� ----------------------------- --------- ----------------------------------- -------------------------------------M---------------- ..-..-•-_ - - --------- ------------------------------------------------------- ------------------------------------------------------------------------ ------- ---- ----------- - ---- ----- Date....___!�e � ---------------------------------------- FINAL INSPECTION BY. A SAN JOAQUIN LOCAL HEALTH DISTRICT '` 1601 E.Hoxellon Ave. -,300 West Oak Street y 124 Sycamore Street 205 West 9th Street i 51a[klOn,California Lodi,California Manteca,California 7racY.California l F.P.Ca. r