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FOR OFFICE USE: ` 3 -t- ----- ------ ? APPLICATION FOR SANITATION PERMIT Permit No. ....................... 1 ----------------------------- -- ------------------------ (Complete in Duplicate) - Date Issued _ -------------------------_------_---------------____ 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. S49. JOB ADDRESS ANQ/JL OCATION..___J--._----__Q - l -t - -G" --' ------- Owner's Name --- ------ ----------- Phone._ J--3T 4--------- -------------------- Address ---•_ -------------------------------------------------------------------- Contractor's Name----�U-"� Ze,- ---------- ---------- Yi ----------------------------------------- Phone----------------- ---- Installation will serve: Residence ❑-'-A`partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ Number of bedrooms _ �---- .2 -- Number of baths J---- Lot size ------��--��--'---------•---------------------- Water Supply: Public system ❑ Community system ❑ Private ept to Water Table C, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Al Previous Application Made: (If yes,date------------------- ) No New Construction: Yes o ❑ FNA/VA: Yes ❑ No 19- 111 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__-5.P-------Distance from foundation---I ---------Material_-,___C-O-- Y _______________ V� No. of compartments-..-----�-----------Size---------------------------------Liquid depth-------`I- ----------Capacity---- --;1 Disposal Fiel Distance from nearest well._,O -_--Distance from foundation----J-49--------.Distance to nearest lot line________ Number of lines- _-.... .. _.._.__Length of each line__ Q7L _.Width of trench___.__ ��`�------------ ---- Type of filter material �_.l---------- of filter material__/57____----------Total length___ _ ____________________ Seepage Pit: Distance to nearest well__.---------.---------Distance 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_._._____---_------------_----- i ❑ Size: Diameter Depth----------------------------------------------------Liquid Capacity - -------------------------gal Privy: Distance from nearest well---------------------------------------_- ---._Distance from nearest bui{din ❑ Distance to nearest lot line___________ ___________________ i - - fa - - ----- -- - ---------------------------------------------- ----- �- Remodeling and/or repairing (describe)__________________ ------•--------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- --------------------------------- - -----------------------------------------------------------•------------•------------------------------------------------ ------------------------------------------ ---------------- I hereby dify hat I repared this application and that the work will be done in accordance with San Joaquin County ordinances, 5�te w , and r n -regulations of the San Joaquin Local Health District. + (Signed)----- ----- ------- --- - ---------- ------------ --------- -- --------------------------------------------------------(Owner and/or Contractor) (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc., cat beeplaced on reverse side). FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY---- --- ---- ----- - -------------------------------- DATE.------7-46; --------------- 1 REVIEWEDBY------------------------------------- ------------------------- ---------------------------- ----- DATE........ -----------•--•------------------------------------ BUILDING PERMIT ISSUED-------------- ----- DATE------------- Alterations and/or recommendations:----� h.�`------- - --------------•----------------------------------_----------------•-----•----- ----------------------------------- ---------------- ---------------------------------------------- ------------ --------------------------- ---------------------------------------------------------- j - �- �n <t �-� ------ --------- --------- FINAL INSPECTIONBY:-- / SAN --- --- Date----------------- / JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slocklort,California Lodi,California Manteca,California Tracy,California F.P.Co. - 'S�