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FOR OFFICE USE: _ q/o S� P Permit No. ` ��` 5. / t } •--.. _ "--___-_- APPLICATION FOR SANITATION FERMI (Complete in Duplicate) Date Issued __9� :--------------- �� 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. 107,02/4 JOB ADDRESS AND LOCATION__ ____ ________ ----- --------- -�. t ----- --------------------------------- ------ -------- ------------ - Phone- -------- -'�.,5-��--•---- Owner's Name_________ ------ -------------- X._/__,_T -- - t� I Address-------------------••---- i• Phone------------------- --------------- - Contractor's Name-------- ---'------�/ -- - -------------------------"---------------- ----- ---------------•---------------------- I Trailer Court Motel ❑ Other ❑ 4. Installation will serve: Residence Apartment House ❑ Commercial ❑ ❑ Number of living units: -j-, Number of bedrooms _ Number of baths _.-'Z Lot size _______________ I � _ Water Supply: Public system ❑ Community system ❑ Private [R"Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam [I Clay Loam [3 Clay [I Adobe Hardpan E]Previous Application Made: {If ye"s,date---- ------ ---------1 No R SaNew Construction: Yes Tr- N. ❑ FHA/VA: Yes ❑ No (� t M TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if Public sewer is available within 200 feet.) , 1, Septic Tank: Distance from nearest well-- `�Distance from fo ation_.-_.._¢--.-.--__Matnai f No. of compartments-------.-__ Size___3_?C5__X _ -- f - _ _ Liquid depth--.---T .�a.--,_ ___--Capacity---- 4 Disposalfield: Distance from nearest well___` -__.._Distance from foundation---_--0-__..Distance to nearest lot line;,__+�_______ Number of lines_____________ i Length of each line- _-7^ ---- --------Width of trench._____-___---_--_-._.__".... Type of filterTmateria i OC K_Depth of filter material_._._� _---- ---Total length.__.___._____�'f ----------------- 1 Seepag Pit: Distance to nearest well---_Z�--------Distance.from foundation-___- -------Distance to nearest lot lin ----- See -.,. -~.--. Number of pits.----_--- -- - Lining material--- v_ceA`_-Size: Diameter----^ . -----.-----Depth-------- ------------------ i ) Cesspool: Distance from nearest well'__:-_-_________Distance from foundation--------------------Lining material-_-_.--_-------_-------.-"-_---_..__ ❑ Size: Diameter----------------------- ---------Depth'�------------------------=------- --- _Liquid Capacity------ --------------------gals. - tj Privy: Distance from nearest well--- earest building__"._______.._.__"..__ ----------------------------------------Distance from n __.---------------. ❑ ____________ _ ----- ----- ------------- Distance to nearest lot line----- � " -��--�--- " 1 ''scribe):------ I ------------!-•-------------- ---- ------- --------------•------------- ------ Remodeling and/or repairing (dei-- --- ----- ---------------••------ - ---------- ! I ------ •� ---------------------------- -- -------------------------------------- --------------------- --------------------------- -., I hereby certify that I havelprepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules"and regulations`of-thq- San J aquin Local Health District. l ! *- � ..__..___.(Owner and/or Contractor) ' (Signe --- =�='---�'--------- --�-- ------------------- ------ - - -- ----- - --------- - --- - ----- -------- 1- ------------------- ------------- l-----"--------------------------------- (Title) ! By- buildings, etc., can be placed on reverse side). 4 (Plot plan, showing size of lot, location of system relation to wells, W ,�£ tFOR DEPARTMENT USE ONLY% I - ---- -- -------------------------- -----1 1 DATE �----------��---- APPLICATION ACCEPTED BY.. ....._ t DATE------------------------------------------------------------ REVIEWEDBY------------- --t ? -------------- ---------- ------------------- , BUILDING PERMIT ISSUED------------------------------------------------------------•------------- -------------- --:=---- DATE-- --- --------- "- -------- -- ------•------ ------- Alterations and/or rec come ati ns:----------------- ------ -_- ---- ------------ - � y 7=t�"_fo Cly- �/---- ----- ern .ice ! rz�`azy" Tom_ ----------------------------- _ --------- r _j t%' 'Date------ _'_�. 6.---------- FINAL INSPECTION BY:.\ � ------------------------- �l SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Slocktortr California F.P.0,J.