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FOR OFFICE USE: <br />-------------------------- <br />APPLICATION FOR SANITATION PERMIT Permit No. _._ ....... _S..`. 5 <br />---------- ------ (Complete in Duplicate)Date Issued _ - �- ---� 3 <br />-------------------- This Permit Expires 1 Year From Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and ;nstall the work herein described. <br />This application is made in compliance with County/Ordinance No. 549. <br />JOBADDRESS AND CATION---L'�u�------!"-i 17----------•-------------------------------------- ------------ ------------------------------- ......... <br />Owner's Name....✓/1/ rf!Y_�L. Phone...._....--•-•--•-------•• --------- <br />- ...... <br />.... -.......................................... ..................................................... <br />Contractor's Name-----1 ---- d............ ....... a ... a Phone .._.... <br />Installation will serve: Residence apartment House Commercial Trailer Court Motel Other <br />Number of living units: _.).- Number of bedroom Number of baths _ __ Lot size /.!"­,>e,Z2--,�7 ------ <br />Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table6-J ft. <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand oam ❑ Clay Loam ❑ CI y ❑ Adobe,[]<ardpan ❑ <br />Previous Application Made: (If yes,date_..----- _-.--- ....I No New Construction: Yes to ❑ FHA/VA: Yes E� No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />i�/� <br />Septic Tank: Distance from nearest well. _..Distance from foundation-_/4--- 1.__...Mat rial__.f�ti i_lG.��................. <br />[ / No. of compartments_..-------- _.._ Size-­,5--L-X­5,-'.e2... Liquid depth-_' .Sl ........ - Capacity ---- � ------- <br />Disposal Field: Distance from nearest well_.f-._ Distance from foundation_._ V _._.Distance to nearest lot line__ �_�__._ <br />Number of lines..............).�.................... Length of each line__ .... Width of trench... nom. <br />Type of filter material../�J p __ 4� Total len th.. <br />li�-----.-_.De Depth of filter material_ --�............. g -/­M­-- le :----•----------.. <br />Seepag Distance to nearest well_#_.__..___Distance from foundation.__.J_v_..__.Distance to nearest lot line ....... .. G <br />Number of pits.-..�--------------Lining material_kAOG _._Size: Diameter_ . ........ Depth. S...;.__ •'��>� Gf <br />Cesspool: Distance from nearest well. ---------------- Distance from foundation --------- ----------- Lining material-.---- --- ........ ................... <br />❑ Size: Diameter- --- • ........................ ---- Depth -------------------------------------------- -------- Liquid Capacity-----------------•----•-- -gals. M <br />Privy: Distance from nearest well.................................................Distance from nearest building ------------------------------------- .... <br />❑ Distance to nearest lot line ------ --------------------------------------------------------------------------------- --- --...... ..------------------------------------ <br />-- ��..0%..._._-.-•--••--------------------------•-----.............---_.......-_.. <br />Remodeling and/or repairing (describe): ........... - .� <br />-------------------------------------------- ------------------------------------------ --------•----.--------------------- ---•-•---•----------••--••-•---.i;r-•------------••-----.._..--•----------------........... _... <br />............................... --------------------------- ------------------ -----------------------------------------------•--•----------------------------------------- •--- ... .------- ---­----------------- <br />I hereby certify ve prepared pplication and that the work will be done in accordance with San Joaquin Count <br />ordinances, State laws an 1 sand re la ' n of the San Joaquin Local Health District. <br />(Signed)------------------ - --- -- - -- ----- --- -------------- ------ --...-............. ---------------------------------- .(Owner and/or Contractor) <br />By:------------- -----------•-- ------ ----------------------- -----(Title)-- �L.'c- ................ <br />(Plot plan, showing size I , location of system in relation t ells, buildings, etc., can .be placed on reverse side. <br />F011 DEPART NT U E ONLY <br />APPLICATION ACCEPTE - ---- - -------------•------------ DATE----------------- <br />REVIEWEDBY..----------- .....------............. ............I.................. DATE-.,._._........ ----- <br />BUILDING PERMIT ISSUED---------------------- -- - ----------- --- ---- . - ------ <br />DRAT ....__--.. <br />Alterations and/or recommendations:------ ��...... --- -- �`.................. <br />........--•--- --------........... <br />.................................................. ----------------------------------------- ---- ---------•----• --- -- <br />..-----------•...................................... ........... <br />------------------------------- -----------------------------•--------- -- _..__..........-----------.--...---------------------------------------------------------- .............................. .------------ <br />...............................-- ----------- ......... - --------•---•----- <br />•------------------- <br />.---------------------- <br />.------ <br />= <br />-•- <br />FINAL INSPECTIO BY:--- ............... ...... _.. Date... --- <br />AN JOA IN LOCAL EALTH DISTRICT <br />1601 E. Mazatlan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />i <br />Stacklon, California a Lodi, California Manteca, California Tracy, California <br />\ [3 9 REVIfii6G 5-39 3M 3-'63 11-11, <br />