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JUK UrrlC.t USE: ,16 _.. .___......-- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - --9-`--- ---------------------------------- --- (Complete in Duplicate) 2 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. 549. JOB ADDRESS AND LOCATION t5 O _ ----------------•-------"- -- ---------------- Owner's Name--- ------- -------- ------ Phone__ ' „ µq- I Address ---•--------------------------------------------------------------------------------------••----------------------------•--,,---ii--/----r/----•--------------------- Contractor's Name-----C L_I7---1 �� - S-CW _ = ✓ .111.L'_ Phone__�i.lG"lb- ` L Installation will serve: Residence ?LiU. tkApartment House ❑ Commercial ❑ Trailer Court ❑- Motel ❑ Other ❑ Number of living units: __r----- Number of bedrooms _..Number of baths ....I--- Lot size -----? ._ .__.X____ .?-S.'__-__--•__--___ Water Supply: Public system Community system E] Private ❑-�Depth to Water Table -4-Oft. Character of soil to a depth a 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IM' Hardpan ❑ Previous Application Made: (If yes,do!te----------.---------I No I'M New Construction: Yes ❑ No X FHA/VA: Yes ❑ No/K TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k Septic Tank: Distance from nearest-well-------------- --Distance from foundation-------------------Material---------------.---------------------------.._.._. ; F ❑ C. ISTI!`tai No. of compartments-{------------------------Size------ --------------------------Liquid depth---------------- ---------Capacity----------------------- 1_� f Disposal Field: Distance from nearest well_ -_-.___..._.Distance from foundation ___ __________Distance to nearest lot line___-__--..-__--__ ❑ x t5T► Number of lines------------T----------------------Length of each line------------------------------Width of trench-------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length--------------------•--------------------- �[ Seepage Pit: Distance to nearest well_. - _0_14.17t;7____Distance frogn foundation___y3, _______._.Distance to nearest lot line..-- �.._ G U0_. Number of pits----=---------------Linin mate riai_:tS,.. - ,Size: Diameter--{'� � g �� - �- -----Depth--------------a7 c"'.'---- Cesspool: Distance from nearest well-----------------Distance from foundatian--------------------Lining material-----._------------------____---_---. ❑ Size: Diameter----------- -------------------------Depth- ----------------------------- - -----------------Liquid Capacity-------------- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_---.-_-..__--.-.___-_-___-_---.-_-_._. ❑ Distance to nearest lot Iine----------------- -`----- - - Remodeling an /or repairing (describe)---------AD.D-------�/-i.,R-- ---•--•-d` A-IiI4-------+Q-------- E- '-------------------------- --------------------------------------------------------------------------------------------------------------------------- ------------------ ----------------------------------------------------------------------- -----------------------------------------------•---------------------------------------------------------------•------------------------------- ---- --------------------------------- I hereby certify that I have prepared this application and that the work will be- done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r , r `_ 4 (Signed) - -------- - ------------- -�.a�----------- ------- ------------------------ --------(Owner and/or Contractor) By:-----------------54 a"a "- --------�=�'7— --- ---------------------------------------(Title)----------- -- -----------0'------- ---- . -- --------------- (Plot plan, showing size of lot, location of system r relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ----------- - r DATE Z -------------------------------- REVIEWEDBY -------- ------------------------------------ --------------------------------------------------------- DATE---------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE - Alterations and/or recommendations:.------- -=--------------------- ---- -----------------------------------------------------••--------------------------------------------------------------- ----------------------------------------------------- --------------- - ------------ ---------------------------------------------------------------•---•----------------------------------------------------------- ------------------------- ----------------- ----------- -----------•----------- - --------------------------------------------------------------------------------------------------------------- --- ----------------- ---- -------------------------- ------ - ------------------------------ - ---- ------------- -------------------------- --------------------------------------- --- ------------------------------- -------------- ------ 1 FINAL INSPECTION BY: �` ---------------- Date ` C� SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slocklon,California Lodi,California Manteca,California Tracy,California F.P.C C.