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FOR OFFICE USE: -----------I------ ------- ----- -------- ------- APPLICATION FOR SANITATION PERMIT Permit No. aV_S5;� ---------:------- ------------------------------------ (Complete•in Duplicate) . This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct mall the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AtJLOC TIO ir - -k- -Pi �' . ' r �.. /� Owner's Name---_--.-_ ---_---- ------ -------------- Address----------------- ,�[. - *'� '-�' �� ---------- 1-4 -- --op----------- -- Contractors Name- ins 5 --------� � ca r v' -- - - _------_--- Phone.--.-....---•-------- - --- �--------•-------- ---••�•------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 2311" 14 Number of living units: -- _____ Number of bedrooms --.----- Number baths -------- Lot size Q— gt Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ - ft Y Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay 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 __......_E........ ❑ No. of compartments.-------- � ...............-----------Size------•-- --------- -----------Liquid depth.-------- --- - Capacity --- i Dispos Field: Distance from nearestrwell._,P=_=Distance from foundation---.-/2__/-.._.Distance to nearest lot line.--�� __-... Number of lines=_�.�--- -------------"`----Length of each line--...__4FA_°_..._---------Width of trench..Z__�------------------------- t � r1 f�A Type of filter material-------gi-1 _Depth of filter material---_./_i--�`-------Total length----,,fQ �-------------_--------_-- Seepa, Pit.. Distance to nearest well--.. �-_-_Disfiance from+7foundation_---I ------ Distance to nearest lot line__ 1 Number of its__- - [.--__.-.-.Linin material.---_--./.G_r . Size: Diameter._..-- - # ° : ;. p 9 Depth -' -------- ---------- Cesspool: .-Distance from. nearest)weli -_.---- _.--Distance from foundation______-----------__Lining material-.._....`x.----.._..-.---____.__.__. ❑ Size: Diameter ---- --- ----- -------Depth------ ------------------------- --------- - ----- Liquid Capacity-------------- -------------gals. Privy: Distnfro�mmnearest eft_ %-_-___________________._..-.-.__ -_.-_Distance from nearest building.-------._._----_--______---- ❑ Distance to nearest lofi'line ----------------------------- Remodeling ------------ ------- ---- Remodeling and/or repairing'(describe)_---------_---- __ ` •-�.p :.� -----------------------------------------------�14--------- --------- ---- - - - --- ��--------- - ----`-'�-- - -°h=--- ----------------------------------------------------------- ----�------ate-#-------------------------- ------------------------------------- ----------------------------- ------ - ----------------------------------------—------------- --------------------------------------------------------------------- --------- -----------------------¢=------- ------------- - I hereby certify that I have prepared this application and that the work will 6e.done in accordance with San`Joaquin County ordinances, State laws, a 'rules and regulations of the San Joaquin Local Health District, (Signed)- �{ ' ^�nd/or Contractor) By: - 'r (Title) i of plan, showing size of lot, location of system 0 in relation to wells, buildings, etc., can be placed on reverse(Plside). a FOR DEPARTMENT USE ONLY l t APPLICATION ACCEPTED BY -------- ------------------------ DATE_-/ „, 1 - --------------------------- REVIEWED BY----- ------------------- - - DATE 1 ---------- - ---------------- - ------•--- UILDING PERMIT ISSUED ------------ - ------------ DATE t Aterations and/or recommendations:-...... . I --- --------------- ----- ----• -----------------•----------- ----------------- ----- ------------------ ------------ ---------------------- ------------------------ ----- ----- - - -- ---- ------------ -------------------------------------- k ------------- ------------------- FINAL INSPECTION BY:-._ r / k : ._ .. _ Date-,� Y v y�--- --------------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street ii;Aton,California Lodi. California Manteca,California Tracy,California . E.H.9 2M 1.67 Vanguard Press to