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F R OFFICE USE: roe L n ----- � APPLICATION "FOR `SANITATION PERMIT Permit No. ... ..�1_I •-•--.---------------------------------------------- ...............................---------------------- (Complete in Duplicate) __ _ .. _._ This Permit Expires 1 Year From Date IssuedDate Issued ._.-_._ .. ....._.. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de;crbed. This application is made in compliance with County Ordin rice No. 5 9. �t✓ ' b r9` j7iO" �040� �J. titl�GE GlxOt/>~ �P/J`` - Q1 1- F tl� JOB ADDRESS AND LO AT N_!t!' j 'wr �� / :......_ Owner's Name...... - -- •------••--•---•---------•---- Phone.........-........---..... .. Address........... ........_..............................- - - Contractor's Name--------- ...........-_....................•------------•-----...-__............................... Phone..........................._.... Installation will serve: Residence Apartment House ❑q, Commercial [I Trailer Court ❑ Motel ❑ Other p Number of living units: _-/_. Number of bedrooms _.Z___ Number of baths X.._ Lot size � f�/-----••- - Water Suppiy: Public system ❑ Community system ❑ Private 2-IDepth to Water Table _,W- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: 11f yes,date ------ ---- -_..) No New Construction: Yes ®'�No ❑ FHA/VA: Yes 4p— 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 wel ..(OQ.�___Distance *m/fcayndation__. // Materlal_Ll_f�_. t'4'_ _._...__.._v_.... ®/' No. of compartments__. -----------------Size"XrQ,�i��Q.Liquid depth.. ----•--....-_----CapacitylQ____._-._-- Disposal Field: Distance from nearest welL.�IQ...._Distance from foundation---/-.--____-._..Distance to nearest lot line+........... -- UK- ` Number of lines------- Length of each Iine..,l�Q--_.� _ Width of french___._._._�________________...._ Type of filter material_, r,- Depth of filter material- ,` -----------Total length__."_A#-------------- - Seepage Pit: Distance to nearest well. Distance from ffouugdation._4K'0_'w4_.._..Distance to nearest lot line .......41 , 9k,__ Number of pits.... __-_ l- --- _.__Lining materia -. rim---Size: Diameter.,,2�._..___--.Depth�y' �1��. �•• Cesspool: Distance from nearest well-------------_---Distance from foundation........._--------Lining material-...____••-•---------_-_--..__�� ❑ Size: Diameter-----_------- --.Depth---- -----•---• ----•......................Liquid Capacity-------•- •-•--•-•------gals. Privy: Distance from nearest well.................................................Distance from neares+ building--------------------..----.-------.---•• O ❑ Distance to nearest fat line..........................••'- _---_-------._-_---_...- _-..- O - Remodeling and/or repairing (describe):-- . �6�/ --------.---_....�...•---• �P ----•.......................................•-----------•---------- --.........__....... _... .... . •..................•-•-----•-------•--••-•----------___-•---.----•---•---................-_....---...._----.....................-..............................................................-----__.----------- I hereby certify that 1 have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws and rules and rguiations of the San Joaquin Local Health District. (Signed)-----�`i /�a'� ------- (9-1 MMWQE Contractor} ---- ----.-.. (Title) By:.....-----•------------------------------------- --•-•- " (Plot plan, showing size of lot, location of system in r ron to wens, buildings, etc., can be placed on reverse side). g FOR DEPARTMENT USE ONLY IP - j P APPLICATION ACCEPTED BY................•.•.......•------------------------•-••--------- - DATE..__. '�.! �•- ___..._.. REVIEWEDBY------------------•.---------•--••------ •-•----•----------•-•---.....---.._..... -------- DATE.................. _ - - _ __. _ 9 BUILDING PERMIT ISSUED........................... .................... DATE-__.-—------------------- Alterations and/or recommendations....................... ......-•---•---•--•----••----•----------...._..--.-..._....._...-..................._........ ..........................................................._................................................................................._.. ..................................... _._._--•--•-----•--.--.._..-.--------..----..___..---------•----.._-•----.._-_..•......--..............................- - -- .................-.................................................... ...................................................................................... FINAL INSPECTION BYeG� - - ------ ----------- -.. - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stackton,California Lodi,California Y F Manteca,California Trocy,California F.P.1;O.