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-------------------- ----- -------- � x,_-.. Af ,ICATION FOR SANITATION PER(. Permit No. ------- --------- (Complete-in Duplicate) ' --- - ---------------- . ..... This Permit Expires 1 Year From Date Issued Date Issued fl:1r -/;-, � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo k herein described. This application is made in compliance with.County /finance No. 549. JOB ADDRESS A LOCATlO _ .-..- . . -- -- Owner's Noire_ _ --------- Phony'" r � Address -- --••-----------� ------- -- ----------------------------- ----•------------------------------- _I i! E G Contractor's Name_.: . ... ------------------------------- Ph ��Y . gg i Installation will serve: Residence .; Aar`tmen House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of livingunits: _ Number of bedrooms i---- Number of baths __L._ Lot size �C)-?�__,f._�------------ - -- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 757ft i Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: [If yes,date_----------------- 1 No New Construction: Yes E] No�HA/VA: Yes I No TYPE OF INSTALLATION AND SPECIFICATIONS: K (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-----.--------------Material ----_._-.------__--___.__.__'I___.- ._._._.__.. ❑6LrS`hN G No. of compartments__ ....Size------a------------------------Liquid depth--------- ------ ---- ---Capacity---;------------------- Disposal Field: Distance from nearest Leng#h of each I'rne_AP_ '-jB3C_ .S .r..Width of french---- njI well Q&'._.Distance from foundation. _,7__.__._..Distance to nearest lot Ii e___5 ( Number of lines.___Q- . .r_[.r.. I G Type of filter material-- -SiC Depth of filter material.......................Tota# length----------------------J1---------_--------- Seepage Pit: Distance to nearest well_ 96AX-7.-__Distance om f undation__-. ., r - �,�_______.Distance to nearest lot lm� Number of pits__ ., _ -_ -A.Lining material__-.. Size: Diameter._—3_f!___...__-Depth._.. 77-------. Cesspool: Distance from nearest well ................Distance from foundation--- - ----------- _.Lining material-._ -- aterial_ _... El Size; Diameter_ __ ____ ____---- - ------------ -Depth------------------------ --------------------------- Liquid Capacity--- -----------I'- --------gals. Privy: Distance from nearest well-------------------___-__---..-._....-----._.._Distance from nearest building-------.------------------____ - ❑ Distance to nearest lot line -------------- - ----------------- --------- - ---- , Remodeling and/or repairing (describe= ------- - - ------------------- ---------------------------- --------------------------------------------•---------------------------------------•-------------------- -----------------------•------------------- --•-------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ I hereby certify that I ha v prepared this application and that the work will be done..irL' accordance with San Joaquin County ordinances, State laws, and ul and regulations o he San Joaquin cal Health District. i o (Signed) ' 9 --o --------------------------------------- ------- ---(Owner and/or Contractor) By: ------------ - ------(Title)------- - + .. - (Plot plan, showing size of lot, location of sy em in relation to wells, buildings, etc., can be plat on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... ..... -- ----- --------------- -- --------------------------------------------------- DATE----- ��---------------`------------ -- REVIEWEDBY------------------ ---------------------- -- _- ------------------------------------- ------------------ - I -------- ----- DATE---•------------------------ ------------------ -- BUILDING PERMIT ISSUED-------- -- ------- _ _-..... --- ---._- -_------ DATE--------------------- - -• Alterations and/or recommend ations•....- l ! ------------I--------------------- - -------------------------- ------ -------------------------------- ----- ------------------ ----------------------------------- ------------------------------ :i ---- ----------- - -------- ---- - ---------------- --------------- -------------------- ------- Date FINAL INSPECTION BY:�`` ' --- �`- � ------ -- --- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Sir Slacklon,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press