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i FOR OFFICE USE: -------------------- Permit No. --------------------------------------- - � APPLICATION FOR,SANITATION PERMIT { -- ------ ' -------------------------- 4 (Complete in;Duplicate) Date Issued This Permit Expires 1 Year,From Date Issue x , Application is hereby made to the San_Joaquin 'Local Health District=for a.permit to construct and install the work herein described. This a,plication_is.made.in..compliance with County Ordinance No. 549 `'t 04$� �to�-f JOB ADDRESS AN L ATIONI_ ._ Qom_ r � -------------- i t. g-d one:_.. Owner's Name---- ;V ame--- - ., -- r t .3' -- -- ------ --------------------------------------- Address ! ------------ ----- -- -- - ---- ---- - / � Contractor's Name. -- Ph one - - -- ❑ P Installation will serve: Residence Apartment Hou ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other:1 Number of living units: :__._ Number of bedrooms Number f baths ___ ___ Lot.size ---- -_- "-"-- _-•- - -------• Water Supply: Public system El Community system El Private J Depth to Water Table ---------,ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam EDClay Loam ❑ Clays Adobe [j Hardpan Previous Application Made: (If yes,date--------------------)- No ❑ New Construction: Yes ❑� No ❑ FHA/VA: Yes ❑ No El TYPE'OF INSTALLATION AND SPECIFICATIONS: l ( septic tank or cesspool per'mitted if public sewer is available within 200 feet.) 3 -V - Vaerial"Septic anyDistance from nearest well__�r~a_ :=Distaa fro- f undation__"- __ ___- . Ca acif No. of compartments . ' Size ...VW Liquid depth _. ---------- Capacity--- ------------- 7 Field: Distance from nearest welk r✓-_.Distance from foundation----lQ __._.Distance to nearest lot fin T______ Number of lines___.__, Length of each line________�� "Total Widtfiof len length french-._. Type of filter material__�!�/____�--_Depth of filter material------ Type 9 I ___.Distance to nearest lot line____ Seep it: Distance to nearest well_._._I_d_o__=___Distance from foundation_____1 a___. d 1 Linin material" ]• " . Size: Diameter_--. Number of its.._--- 9 * C p r - x P � , Cess ool: j„�Distanc.from.,-ne rest welly_____________"__Distance from foundation...._____________..Lining materia-----___._____.___"_.______"__"______. p..: µ Size: Diameter . Depth Li uid Ca aci als. t I Privy: _ Distance from nearest well-------------------------------------------------Distance from.nearest building__.____"___________________---------"--"-. r Distance to nearest lot Gine...._------------------------------------------ --------- Remodeling and/or repairing {clescribe)-------------------------- ------------------•-------------------------=-•------ -------------------------------------------------- -------------------------------------------------------------------------------------------------------------- l -------------•----------•----------------------•--"---------------------------------------------------------------------------- ------------------------------------- ----------- ---- -------------------- ----- ! hereby certify tha a prepared this application and that the work will be done in accordance with San Joaquin County ordinance$. State laws and r s and regul s of the oaqui cal•Health District. c _"_-."- ____...(Owner and/or Contractor) (Signed)_ ------ --------- ----------------------------- -- -- -- _ ,4 - ' By:--------- - --------- , (TItI13) 'f(Plot plan, showi six lot, location of system/in relation t wells, buildin , etc., can be placed on reverse'side). FOR DEPAR MENT USE ONLY APPLICATION ----- DATE--- h r - ------------------------------- 4 -- ACCEPTED BY__ ----------- DATE __1REVIEWED BY------------------------------- -------- -- -------------- ------------ ; BUILDING PERMIT ISSUED----------------- ----------- DATE - Alterations and/or recommendations-------------------- ----------------------•------------------------------------------------------------ ------------------------------------------------- --- ------------------------------------------------------•-------•------------------------------ i. ----------- -------•----------- -----------•------------------- •--------------f---------------- ......- FINAL INSPECTION BY:. •�. -------------------------- Date.... �I`-�G-� - SAN JOAQUIN LOCAL HEALTH DISTRICT /1 205 West 9th Street ,.. V� 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street --T— _- I �==Lodi;'California ''�" 6M1anteca.California Tracy,California Stockton,Cnlifornfa # ES 9 REVISLO B-59 3M :3"•63 F.P.CC. 1 M1 ' 4 ` 7 ,_-I