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FOP.OFl ICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - - - (Completa in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ..............._( Application ii 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 wirh County Ordinance No. S49. JOB ADDRESS AAD LOCATION.._.._.. C. '1 S S�E�l E 5 c'N � : -- .......................•-._......... ..------ ------........................._.......-.-...---------------------- .. Owner's Nam,:----- - `� V_-..{.t.�......:. Phone...... 3�. L"••—•-. ............... . . ..:...�....... S ' - Address..._.._....�..�►..2_�..._.......5. ..�.. ..�\1 .Q..h,........_.� �:...................•--................--•--- . ---.......... ...................... _ 1 Contractor's Name.... . .l.__ ...... . ........................................... Phone.................... Installation will serve: Residence Q-'Apartment House [:I Commercial [}Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. ..... Number of bedrooms .--. Number of baths .� .. Lot size .......�.....>�.�'.Y..S�................... Water Supply: Public system E-] Community system [IPrivate "Depth to Water TablcO--q �7. ft Character of soil to a dnpth of 3 feet- Sand ❑ Gravel [] Sandy Loam❑ Clay Loam (Clay ❑ Adobe❑ Hardpan ❑ Previous Appli%ation hada: (If yes,dote.. ) No Q— New Construction: Yes Er'No [j FHA/VA: Yes F] No E / TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic/Tank: Distance from nearest well... .!Q ....Distance//from foundation-.I.. .......... ............ l� No. of compartments... ... ........Size......14d�g�.i.....Liquid d pth. �._�'�4.*Capacity...................... �A Disposal Field: Distancc from nearest well ... .. I�W�.Distance to nearest lot line.,�� ' �Q...Distance from foundation.. ............ ... --•.-- Number of Imes.........-1.......�_`_.. . .--Len th of each line-. 10C, (17 ..Width of french._7.7-�'..}.,^---- +-•- Type of filter material.....2-VY .�a�pth of filter material._1.�!r`^'� Totdl length ........... (_�1 Seepage Pit: Distance to nearest well. .. ...... . .Distance from foundation... ............ �-QQ { •�. Distance to nearest lot line... -.�....... Number of pits....1..... ..... ..Lining material...NIAC—_ Size: Diameter"_..... .aDeep�ptn.J-4. _)4!....m! yy Cesspool: Distance from nearest well ............. ..Distance from foundation . ... ... Lining materia._..- - ... ❑ Size: Diameter. .. - ....Depth............. . . .... ._ ....Liquid Ccoacity. .........................gals. Privy: Distance f-om nearest well _. __ Distance from nearest building.._ ....................... ❑ Distance to neare<_t lot line ...... ....... ..... .......... _ ............................................ .r Remodeling and/or repairing (describe):._ ,. _................ .................. .................................................................... ....................._ ----- . ....-. ......... ............ ..... _ _....................-.. .------. ................... .......... ......... ...I...... __....... ....._ .... __................ ......_............................ ................... ........... .. .............. ............................-- . . ... ......... .. ........ ._ ._...-... ................. ............................ .....----.......... .......I------ .........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 Sara Joaquin Local Health District. (Signed)----- �6C- -- I . .. (Owner and/or Contractor) U _....- .. .. . Ti le . (Plot plan, showing size of lot, location of system in telafion to wells, buildings, etc., can be placed on reverse side). T FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ... DATE./ . .. ..................... ....... ............ ...........BY..... ................._....... BUILDINGPERMIT ISSUED........ . ..... .. _.. ._ ... ... ..__._ DATE................ ._.. ._ _...,......... _........ _. Alterations anc./or recorr ndations: . . .......... ...... -...........................................--- - ............. •. . ...... ...................... ........ ..... ._. ............... I ..-.... . . . . ... ...... .................. . . ...._ . ... ........... ._ ..... . .. .......... .. -. ..... . .. ...... .. .. . FINAL INSPECTICtJ BY: �r A {.....I Date c A 4UIN LOCAL HEALTH DISTRICT 160i I.Weirelton Ave. 300 Wait Oak Street 124 Sycare_re Street 205'Nest 9th Street t� Sl�ekfan,Gallfornia Lodi Californio Manteur,eallfornia Tracy,Califoroio E M 4 2M 1 Von•h,o•o ore„