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FOOFFICE USE: J g�---------------------c T+-------- ��77 3U APPLICATION FOR SANITATION PERMIT Permit No. .lxl . (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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, 1107 JOB ADDRESS AND LOCATION-. 7 -7- -- ------ ----------- ------_G _ --.QS~-----S- ---U--- Y - Owner's Name------V �:_k_I__T_Ai-J�/�: = __ f=- __I __ -1 _L.., :._:,;.., _ _ ... Phan e ,l&----•---- ff-- -� '-f__`__:f^_.tU.w?_�/_-_��-°•---------- ---- -- -- --- ---------- Ad d ress--------------- f�!I! Contractor's Name .�5. ----------1-M—c-,--r--------------------------------------------------------- Phone.4A e7f1�_Q . f Installation will serve: Residence Apartment_House_❑—Commercial ❑ � Trailer Court ❑ Motel ❑ Other E]y � Number of living units:,--./--- Number of bedrooms _Y Number of baths 1----- Lot size --�.�_�---/A.+D-------------------------------- t Water Supply: Publicisystem Community system ❑ Private ❑ Depth:to Water Table &S ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam El Clay Loam E] Clay E] Adobe [K Hardpan ❑ Previous Application Made: (If yes,date No New Construction: Yes E-1No FHA/VA: Yes ❑ No TYPE OF INSTALLATION'ANWSPECIFICATIONS: (No septic +an0or cesspool permitted if.public..sewerris_available.wi+hin:200 feet.) 1 , 11 i t-`;/ Septic Tank: Distance from nearest well-------------- Distance from foundation.------------------ s - # . Material__________________._._ _...____._.._._.__-_____ __' - ' Liquid depth__-_ _ __--..._ ----- Capacity------ --- ------------ I ❑ 6�� N N of _ Size_ ____'_ _ ____ ___ . Disposal Field: Distance from nearest welL..A_k�__:__:_FDistarice from foundation____----------------Distance to nearest lot line--_---_.---_.._.. ❑SACS+( Number of.lines-------------- - - ---------------'Length of each line---t._I----------------------Width of french----------------------------------- Type of filter material________________________`Depth of filter material--------------_------ Total length-------____--___-_--_-_-------_-----_____- . _ 1 � ifsi� t I Seepage Pit: Distance toinearest well__ —A! Distance from foundation_,P f._______ Distance to nearest lot line._ .-_.._ iIt N jmber of_pits-_®_N_�______Lining material__�DC�.-_.----.Size: Diameter_��______________Depth_.I;;P5_J11`�r.___.__ f Cesspool: Distance Vom nearest well-----------------Distance from foundation--------------.___:.Lining material--------._.-________.______._____..__. ❑ Size: Diameter_,_..- ~--- -__--___,...Depth.------•-------------- i-- ------------------- Liquid Capacity- --------------------- --gals. Privy: Distance from nearest well-.._':`----- .___-'^'- ---------------------Distance from nearest building.-----_----------------------------- ❑ Distance to nearest lot line-------------------------------------------------------------- ------------------------- ---- - -------I- --------------------------------- t7 n Remodeling and/or repairing {describe} ----- -- ------------- -•--- ---- -----------•------------------------ --------------------•------------------------------------------------------•-- •----------------- -- ---------•------------ ----------------------- i 1 ---------- I hereby certify that I have prepared this application and +ha+ +he work will be done in accordance with San Joaquin County ordinances, State law and regulations of the San Joaquin Local Health District. D u - --------- (Signed)_ � p•i S._4 C�____- Owner and/or Contractor - - - ( ) By:------------------- ------- -------------(Title)-- •---------- --- - - -- --------- (Plot plan, showing siz of lot, location*oy,�em in rela+ion +o wells, buildings, etc., can be ph-S-1 on reverse side). FOR DEPARTMENT USE ONLY t � APPLICATION ACCEPTED BY---- - DATE- REVIEWEDBY---------------------------------------------------------- ------ DATE--------- BUILDING PERMIT ISSUED-------------------------------------------------------------- --------------- DA•TE----- ----------------------------------------------------- Alt rations an or reco men atians: ----- c ----- --- /--------- ------------------------------------------ --------------------------------------------------------------- - ------ ---------- -------------------------------------------------------------------------------------- - ---------------------------------------------------------- ----------------------------- - ---------------------------- -- ------------------ _7_ ...... FINAL INSPECTION BY: Date........ ------------------------------ ---------------- 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street 5tocklon,California Lodi,California Manteca,California Tracy,California P