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FOR OFFICE USE: `1............. f' y Permit No. .__t ............... -------- . ..........--•---._ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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 in llll the work herein described. This application is made in compliance with County Ordinance No. 549. It,° t�- W67—0 2_ JOB ADDRESS AND LOCATION_�1�....4.._. ._,7.5`v_.'"�.... ��'rrtic^✓• Owner's Name.-...... ........QArxe4 ................ .... .........-. ---------------- ------- Phone._4liir_.'d.....a.5 .. Address---------------- -----r'-4' 1--- ........------..._..---•..._--•--------•••-••...._•-------•--••----------•-•------------•---------- Contractor's Name...- ....!a.,.� •-•- ........................................................ Installation will serve: Residence &---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: .. Number of bedrooms_f Number of baths Lot size ._d.... ----42.4./LAR4-1.0-------------- Water Supply: Public system ❑ Com,Munity system ❑ Private K Depth to Water Table / ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay 5� Adobe❑ Hardpan❑ Previous Application Made: (if yes,date......... ... .....} No ❑ New Construction: Yes ❑ No x PHA/VA:Yes❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 01 •S tic�Tank: Distance from nearest well.................Distance from foundation....................Material_--..__-.-____--- ----------------------------- IC,No. of compartments---------------------...Size..............................•Liquid depth-----------.......... Capacity------ ------•------ ' 3M ._..._Distance to nearest lot line...;5r ..._..... Dispoosal Field: Distance from nearest well.%5.4... Distance from foundation.. �.... t!l Number of lines-_/......................p. . Length of each line....�0.__--------.......Width of trench.....,.,r?__�/___ ................_-.............. ' Type of filter material. 1.1�° •Depth of filter material...._ ------------ __--__---Total length______________________.gd..,........ Seepage Pit: Distance to nearest well_-.-.-_-_-_...,____--Distance from foundation....................Distance to nearest lot line................. � 0 Number of pits......................Lining material..................--...Size: Diameter._.....................Depth--.------.---------_---••---••--- 3 Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material......................-............... ❑ Size: Diameter.......................................Depth........_...-.-•.....................................Liquid Capacity............................gals. i? Privy: Distance from nearest well..--- ....................11...............Distance from nearest building--------------------------------.-____--. �• ❑ Distance to nearest lot line f---�. .................... .. ....................................�...............•...--/-�...._...._.........._--------------..�. Remodeling and/or repairing (describe):.'eZz ...�. ,^ ------- --- -' �+ '"='�j ...........................................Q.._.-...__....................--------•--------------- .-•----•---•-....__-....._....__.........._...._.-.....--- - .•-•------------------•----•-------•---_-------•--•----.......................-----------------------------•-............----------.........................................................I................ I hereby certify that I have prepared this application and that+he work will be done in accordance with San Joaquin County ordinances, +e laws, and rules and regulations of the San Joaquin Local Health District. (Signed)•-•-- --4A4AA4_-_-k--- ..._�j_'..�.._'�_'.�"'._-_.......... ......--• •------�•--•-•• -------------------•....... wrier and/or Contractor) By: ....................t•'�r•�"`.... 5...•....... (T'itle}... ..-....................... (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' ---------------------- -._ DATE-----•-�� " -..b...r...... ........ APPLICATION ACCEPTED BY. REVIEWEDBY...............•------ ..------ ----------------_- .............................. DATE......------------------------------------------------------ BUILDINGPERMIT ISSUED................................... ........................_....• ......._...-----......._...... DATE-._....-_-------•-------•-----------------------•--- .._... Alterations and/or recommendations:................------............................•-•-------•••--------...-----•-...-----------•-------------------.......................................... .......................................................................-----------------------------------._.......---------------...-------•--------.....-------•--•---•-----...... ........................................................................................_... ..................................,_._..-----------------------------••--...................................................... ...................................................-.............................................................................._...-----........................-•--...----..............,.... ...........--............................ .............................. ........---.------------------.............................-........................... � z . FINAL INSPECTION BY:...' .. -- ......... Date-...�Ap .._C .• ...-.---•-----•----•-------•-•----.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Avg. 300 West Oak Street 124 Sycamore Street 203 West 9th Street Sloaten,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8-59 3M 3-'63 r.P.CC.