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FOR OFFICE USE: ----- ------------------ -------------------- ------------ / SANITATION PERMIT Permit No. .1 -.:�...___ APPLICATION FOR A plicate) it �� ' --- ---- ---------------------------------------------- (Complete in Du Date Issued ------- ? - 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. " JOB ADDRESS AND LOCATION_ �"M"` s � Owner's Name � j 6 Phone---�f_ __. 2�1�' Address.-J__.2--� Alir u C`` =` -- ---------------------------------•-•------ •-------------- -If-----. Contractor's Name_VZOIL-- -------- -------- ![_t-•-••---------------------- Installation will serve: Residence /Apartment House Commercial Trailer Court ❑ Mote! ❑ Other ❑ r a Number of living units: _/---- Number of bedrooms _.3__ Number of baths __/-_ Lot size . -- I Water Supply: Public system [I Community system ❑ Private Z,-<th to,Water Table e55 ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ San oam lay Loam ❑ Cl y ❑ Adobe❑ Ha pan ❑ Previous Application Made: (If yes,date------------ -_---) No New Construction: Yes E]No FHA/VA: Yes No -- ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:- T (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .. Septic'Tank:---'Distance from nearest well_ 2i_-_____.Distance from foundat' n�.10_____�---.M�r l__.__ ---____-._. No, of compartments-------------- ---Size �xC__�_�71R�:..1quid depth..f3Gj---------____--Capacity-_,f_a-4�� Disposal Field: Distance from neares well -.Distance from foundation. -.0..__.__.Distance to nearest lot line__f�__��,.,. Number of lines____ ------------------- -----Length of eachline �- Width of trench.._._cx2 _!!._...__.______ rater Type of filter rial� .Depth of filter.mat rial________19-of---Total length_________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation---------...--------Distance to nearest lot line---____._____ ❑ Number of pits---------------------Lini g material- ------. ------Size: Diameter------------------------Depth------------------------------- �~ d-S Distance from rsearest well__///_______________Distance from foundation__________._____..Lining material------------------------------------- Cesspool: p ❑ ' -----------------.Depth----------------- ------------------- -- ---------Li Liquid Capacity :---- t als. Size: Diameter.------------- --- - r q . . p tY--------------------- 9 I Privy: Distance from nearest well-__-.____:.--_'1'-` ----- '----Distance from nearest building------------------------------------------ ❑ r --------------------------------------------------- -Distance to nearest lot Ilne- - ----------- ---------------------------------------- Remodeling and/or'repalring (describe):---------'---------------=-------------------------------------------------------------------------------------------------------- ------------------ t e ---___.___.- _-_ I j -----------__-_- ---____.__.__ ----------------------------------- ----••-----------...------------------------.._--------' - l ! hereby certify that I have re ared this a lcati• i on and th�at'fhe work will be done in accordance with San Joaquin County. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i ---- _ ;Contractor) Signed ' (T By=------------------------------------------------------------------------ ==_ ' - - it e) - (Plot plan, showing size of lot, location of system in relati to wells, buiI in , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t ----------- I APPLICATIONACCEPTED BY--------------- --------------------- ------------- -------------------------------------------- DATE------------------------------------------ REVIEWEDBY-------=----------------------------------------- -------- -------------- ------------------------------------------- DATE-----------------------------------------------------------, BUILDINGPERMIT ISSUED------------------------------------------- ----------------------------------------- DATE------------------------------------------ ------------------ -Alterations and/or recommendations:_- _ _ _ 1 #,. "°:...._ti ;.- -- ----------------------------------------•-•---------------------------------------------------------'-' k-` --------- ------------------------------------------------------- - - ----------- ---- - ------------------- ---------------------------------------- ---- ------ -- -- ------------------------- i ► ---------- -------- -- ---------------------------------- ------------------------ FINAL INSPECTION B� - Date -- ---------------I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocklorn,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.