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FOR OFFICE USE: - - f''" -- . {APPLICATION FOR SANITATION PERMIT Permit No. .L.. .-(�:�-.- -----__, -19-�,5. -�._ _ <' (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. -�--- �� s _ ---.._________________ JOB ADDRESS AND L ATION ------� �_-�-`�------ -C F------rl_.----- -1� ----- -----------------------------------------�----- • - I 7 L/ Owner's Name-------c � -/`� = �!,!' I_�5/--------------- ---.-- Phone Address-------------------------------------- ` % :.r�-- L_�_ ---------- ------------------------------ 4 Contractor's Name { � ✓ l s1.�E1.0 ----- -------- ----------------------------------- Phone--------------------------..------- Installation will serve: Residence [`f partment House ❑ Commercial ❑ Trailer Court ❑ Mosel Q Other ❑ Number of living units: __/____ Number of bedrooms _ -_- .Number of baths-____ Lot size ---vp�rl�________________________.__._ Water Supply: Public system community system ❑ Private ❑ Depth to Water Table(,7- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Adob Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction:. Yes ❑ No A/VA: Yes ❑ No;©�-a TYPE OF .INSTALLATION AND SPECIFICATIONS: y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j t r Septic.Tank,{ Distance from nearest well___`r -----Distance from foundation---/P-_-__._Material __.'_______________ ✓0! p Liquiddepth-------------------------Capacity----------------------- Disposal Mlda Distance from well.___~--_.. Distance from foundation___ _d __-_.Distance to nearest lot line_`��_.._____ IJ Number f - Number of lines.-_._-.-__�__--/ ._._-`/._�-Length of each line___._ _ }___._.Width of trench._ _!�C-----_---__________ Type'of`flEfer'material-__l .Z'--____ -Depth of filter material ___. Total length_,. _____________________________ _ } Seepage Pit: Distance to nearest well-------------- __Distance .40M on`__ __f}__ __.Distan e to nearest lot line____ -4v---�_-_. it [�_ Number of pits_}-- -------------Lln,ng material_ C/,6., ------Size: Dlameterd-- 4/44------Depth� -. � -- ------- V) Cesspool:ool: Disacefrom nearest well_'---- - Di Distance from foundation -- Lining material_.-.__._---___..____._..__________- ❑ --------------' DEI -- - -- rn I s.-Liquid Capacity-------------------- -----gals. r Privy: Distance from nearest well. - --------------------------------------Distance, from nearest building--------------------------------------- Distance to nearest lot line- - -=-x--'---------- ------------------- --- ---- -------�---------------------------------- --------------------------------------------------------- �/ �� ------- �� ---+----- -------------------------------•------------------------ Remodeling and/or repairing (describe}----------------��1i2f----`"1J f�� r r g s 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,-bv rules and reg lations of the San Joaquin Local Health District.1 a -- ---- l Contractor) t (Signed)-------------------101-1v------ l4 ------------ (��r C tor) �� t Title [Plot plan, showing size of lot, tion of system in relation to wells, buildings, etc., can be)placed on reverse side]. f FOR DEPARTMENT USE ONLY i APPLICATIONACCEPTED BY---------' ..,o------------- --------------------------------------------- DATE----- ----------------------- REVIEWEDBY--------------------------------- ---------- ------ ------------- ------------ ------ -------------------------------------- DATE-------- -----------•------------------------------- -- BUfLDING PERMIT ISSUED --------------------------------------------------------------------- DATE Alterations and or recomme dations------ ------------------------------ ------...---------•---------------------•----------------------•-------------------------------------------------------- dAl� ----- ..... -'��------------------------------------------------------------------------------ ------ ------------------------------------------ -��,--------------------------- - ------ ---------------------------------------------------- ------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- ---------- - ------------------ --- - - ------------- --- --------- - ----------------- -- . -------- --- --------------------------------------------------------- 1 FINAL INSPECTION BY: r ----------- - ------ -------------- Date----------- sC�� . ----- ---- -------- ---------------- 4 SAN JOAQUIN LOCAL,HEALTH DISTRICT 1601 E.Harolton Ave. 30o West Oak Street 124 Sycamore Street 205 West 9th Street 51ocktonr California Lodi,California Manteca,California Tracy,California • F.P.Co.