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fF R OFFICE USE:--- ---- APPLICATION FOR SANITATION PERMIT `--- - -------- -------- ° � � -------- ------- ----- --- (Complete in Duplicate) Date Issued made to the-San�J his Permit Expires 1 Year From Date Issued ---------------------------------------------- ---- - - Application i- hereby oaquin 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. i f JOB ADDRESS AND LOCATI N----li-1-11,0,e-z- ------- ?r / _/`f � / T•Lf Owner's Name-------------------Y `' /---- -�-_ --- ------------ -------------- ------ -- Phone__ _, - _ . Address----- ----•------•------ -----. _� .... F._--•------ --- --------------------- -- ----------------- Phone 11--?1�f� Contractor's Name-------------- ._. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I... Number of bedrooms`_..T__ Number of baths a�_ Lot size __-_____.__ Water Supply: Public system ❑ Community system ❑ Private gj--Depth to Water Tabletk'_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sandy Loam ❑ Clay Loam [a5--Clay ❑ Adobe ❑ Hardpan ❑ El Previous Application Made: {1f yes,date..- 1 No New Construction: Yes [t}�o El FHA/VA: Yes Q--No i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) /9~ - --Material_._/.J[CCt ,S'T---------------- Septic nk: Distance from nearest well_:3�'____--Disian '?� 4 u anon__ _1________ r No. of compartments------ Size.---_--- �-i- ---- --- --Liquid depth---��--- - ---------Capacity.2 ---------- Disposal - 7 Disposal 'field: Distance from nearest well_= J__._._.Distance from foundation.--9 --------Distance to nearest lot line---___ --•••• Number of lines______________�----------------Length of each line___-___ ____.Width of trench_ -------------- Type of filter material_v,�'Q �--Depth of filter material___f f�_-------.Total length_____ __ -_ ----�--- Seeps Pit: Distance to nearest well_/rP--/__--Distance fr m foundation__: " ____..___.Distance to nearest lot line__' _._:_-_ e Number of pits_______-----------Lining material_`V/d&0_ �'_.Size: Diameter____ .--------- -_`----------------- --- cesspool: Distance from nearest well-----------------Distance from foundation--._-_-_-_-___.__.Lining material-----------___--________------ als. ❑ Size: Diameter----- - --------- -----Depth------ ------------------------------ --------------Liquid Capacity------------------;--- g ------------- Priv Distance from nearest well_________________________________ -------:-_-Distance from nearest building____-_._______-_____________________.._. Y. -------------- ❑ Distance to nearest lot line---------- --------------------------- -------------------------------------------------------- Remodeling - '-------------- ------------- Remodeling and/or repairing (desctibe):-----A-1-a')---------- 1 - - -------------------•------------------------------------------------------- --------- ------------------------------------------r---- ------------------------ 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. `r �` nd or Contractor (Signed) 1�_ .1��-l -. <----------------------------------------------- caner / p Title - r--------- - I 'C�f CJ-------------- [ Sy:--------------=----- (Plot plan, showing size of lot, location of ystem in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY 1 f f.PPLICATION ACCEPTED BY-- ` = -----------/I------- - � DATEy /h r� i REVIEWED BY --- ---- ------------------------------------------------------ "'DATE DATE -------------- --------------- BUILDING PERMIT ISSUED---------- { --------------- - - :. -------------- -- ------- - Alterations and/or recommendations:-_____y ._._.._ _ ` f- 1 -- ------------------------ - i. ----------------------------- ------------------______ --------------------------------- ---------------------- ------- -- --- FINAL INSPECTION BY:.... - ---- ----- ------ ------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT ! 124 Sycamore Street 205 West 91h Street n Ave. !' 300 West Oak Street 1601 E.Ha:ello yl Stotklon,California I.odi,�*4California Manteca,California Tracy,California l• � F•P.0 C.