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FOR OFFICE USE: ..............I................... ....................... ......... .... . . . _._.. . I APPLICATION FOR SANITATION PERMIT Permit No. ./.;�Z�a.. ....... ........ ......._.. (Complete in Duplicate)........ Expires 1 Year from Date Issued Date Issued ,/-.r2:.7f..`�..... I This Permit r�'•'A''�" 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. �-. � �.... .},:,: .. .G!%.. ..................................................... nn JJ � Owner's Name....../Y. Li� v... ..... Phone..................._....... _... Address.. C.r.....�.t..../3 k.--1....... riL.. ...............�L'�ri�. ..........................._...... _... Contractor's Name......................... ��xu................................... .............. Phone............__............ ......... a; Ins+allation will serve: Residence Apartment Hous-- ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.{.... Number of bedrooms. .. Number of baths .I..... Lot size .�C(il�� .---_-.-------•--------------- Water Sunply: Public system ❑ Community system ❑ Private ® Depth to Water Table/. it. Character of soil to a depth of 3 feet: Sand❑ Gravei ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe❑ Hardpan J21 Previous Application Made: (If yes,date- . _ _._ - I No ❑ New Construction: Yes ❑ No ❑ FHA/VA:Yes❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu::,lic sewer is available within 260 feet.) Septic Tank: Distance from nearest well.................Distance from foundation...................Material................................................ ❑ No. of compartments............ ..........Size...............................Liquid depth........................ Capacity...................... Disposal Field: Distance from nearest well.................Distance from foundation....................Distance to nearest lot line..........._.... ❑ ......................Length of each line..............................Width of trench.................................... N Type of filternmatenW'...... ..................Depth of filter meterial......................Total length...................................... Seepage Pit: Distance to nearest ell./A?...........Distance from foundation... .0.........Distance to nearest lot line-l.'...4..... x Number of pits..../........... ..Lining material, /�:...._....Size: Diemeter.... 3.�..�...-....Depth..?-.f�.................... s! Cesspool: Distance from nearest well................Distance from foundation....................Lining material..................................... w ❑ Size: Diameter.... ...............................Depth............... ..................................Liquid Capacity............................gals. i Privy: Distance from nearest well.......................................... .....Distance from nearest building ! ❑ Distance to nearest lot line.......................... �Remodeling and/or repairing (describe):............. ......�1 ..o.............•---..... ........� _ ....... .........................------•--•-•--._^..._................. .........................................................................................................•------.............._.......---............_............-•--•---••-----....---•--....._.......................... I horeby certify that I have prepared this application and that the N',•k will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Locai Health District. k " i i (Signed)._. !✓1:. A/t!4 LGfi!ylLa lil!!1.........................."-....................................................(Owner and/or Contractor) 1 Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can bo placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.........-:jtr �,�- - l> ................................................ DATE... ............................ .` REVIEWEDBY............................... .. .............. DATE......_............... BUILDINGPERMIT ISSUED.................................................................................................... DATE............................................................. Alterationsand/or recommend a+ions:...........................................................................•---..........................._._................................................. i ................................................................................-.........................---............................................................................................................... i i FINAL INSPECTION BY:.. .. Dete.. .'7,. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoteliers Ave. 300 West Oak Sire*? 124 Sycamore strew- 205 West 91h Street Y, sicckton,California Lodi,California Manteca,California Tracy,California , q 1