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FOR OFFICE USE: n n ---- _�.................................... ----------- APPLICATION FOP. SANITATION PERMIT Permit No.....__ ------------............................... ---------- (Complete In Duplicate) s- I. .............. r Date Issued This Permit Expires t Year From Date Issued 51 i. Application is hereby:.made to the San Joaquin Local Health District for a permit to constivct end instah'the work h re7sc This application is made in compliance with County Ordinance No. 544. Q �. ,3 _ 2� p t{ r'q Mf 4v//x -4 /0 JOB ADDRE=SS AN ATION 4�.___1... Owner's Name....._ �--------_. - '+-:_---- . Phon .._.__.....--..._.._..... it 'Rr� - - =Address •--- • -• •--- .._ .._ ... '-_".....------------------------------------------------------------------•---_-_--•------____--••--•--Ph one______________ -- ................ t - Contractor's Name.... Installaton will serve: Residence *--'AA`partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - .__ Number of bedrooms S-._ Number of baths ./.. Lot size................ �. Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table f6.!4 -V 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 ...... ._j No Z?"* New Construction: Yes U3"'No ❑ FHA/VA: Yes 9?' 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 w !-l.�...._Distenrom fo ndation..IX-_________.Ma# Jial.-G!_�r.�....___.._. No. of compartments. .............`_5izel6►_ i"�G' liquid d;pth-__-��.--............. r s Disposal field: Distance from nearest well_��_ Distance from foundation_AO.- _.......Distan a-to-nt crest lot line.�.� �_... a e: Number of lines..... Length of each line_ � • I . a` y .. 9�Q �� th of trench ------------------ �' Type.of.filter materlal�� -Depth of filter ma+erial..%�__.____./.Total length_._ _X49 ........................ .. 5i .ege.sl?t:; Distance to nearest well...!�49.__.... Distance from fo dation.. ::.:.Qistance to nearest lot line "''Number of pifs....t.......-•__--Lining material__A..Size: Diameter_--..........Dep+h•�:. ;.P ;SCes gogl: R..' -Distance from nearest well --------------- -Distance from foundation __...... •---------- Fining'material...._................................. ❑ Size: Diameter ....................................... Depth .............. ...................................... Liqu+d Cap�clty_- ......................... gals. r Priv Disfunce from nearest well ___-.- ........................................... Distance from nearest building `cd" ❑ . _______________________________ ____ __________ _________________..�._....._______—___-__-...___..a_. •.• . SYin. �:___�-. ��ti � �i•� :_.. Distance to nearest lot line. y ' .._. ._ ._ . .. . .. .......... .................... .. ( 1, Remodeling and/or 'repairing (doscriba):__....`-. / ..ia _.--- -------- -- L., .!s ..--•-•------------•----•-----•------------•---------------------•-----•------•----••-------•-----------.....--------•--------•I.....---------•--••----........--------•--••--_..------------------------------------------ I hereby certify that I have prepared this application and that the -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 Signed}----------------- r ._... ... - --02 ......... �ar Contract :R By:........ ..................................-•--•--•---- ......................... (Titlel '...:.. .........: j (Plot plan, showing size of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). t r F0jt DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ............... ---••-.............:.`_._ DATE__.___.......:' .. -''r----------------------------- REVIEWED BY --•----• 1_------�....�_ -.. .................. ... r-` - DATE.--- - .................----••-------------------- BUILDING PERMIT ISSUED _ ................................. A.-_ DATE •---•---------------------------------------------- Alterafionsand/or recommendations----------------------------•----------------------- --------•- .......... -- ------ ................................ .................................. ........ I , -. �-- • -�-` - - .................................... __ ,+ .-- ._....:...............................................•---•••...................... .-------••-----................:..•-••--"-----.......... ---------------- - ------------------•----..---"--............................................................ - -------------------------- --- FINAL••iNSPECTiON BY: ... - _ _-r/ 1. . . ....................... -• •�F. SAN JOAQUIN LOCAL HEALTH DISTRICT n 1601 S, Havelton Ave. 300 Wast Oak Street 124 Sycamore Street 205 Wast 9th Street Slocfrtotl, Ccllifamla Aodi, Califamla Manteca, California Tracy, California �'- 3