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F`QR OFFICE USE: t _ ------.----------------1Permit No, XPPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued_✓r-l�-- � --------------- - -------- --------- -- ------------------ -------- This Permit Expires.1 Year From 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. . 549. iAle JOB ADDRESS A D LOCATIO , ----------- ------------ Owner's ----------Owner s Name.___ ------- ----• - -- ------ Phone--•--------------------------------- - t_&_o0---- �_ _.;A*4 •---- -------------- -- ---- -----------Address__=____.____ Phone---•-----•-------• ----------------Contractor's Name_ -•Installation will serve: Residence ,[!rrApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -- Number of bedrooms __ - Number of baths-r.----- Lot size ----------------------------------------------------------- Number of living units: _�_ { Depth to Wafer Table 4.6 ft. Water Supply: Public system [��ommunity system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,dote____________________) No ff- New Construction: Yes [&-'N-o ❑ FHA/VA: Yes ❑ No J9;__ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p rr ------ Barest well from foundation_f4______________Mate�al'___I__ -__. Se tic T k: Distance from n Li uici de th__-.-_ ___.Capacity- No. a acit �-- No. of compartments_ ;"h Size A�r q P. P Y . Disposal F- Id: Distance from nearest well._.`____.-.-_Distance frim foundation-_-/a______-.-.Distance to nearest lot i f__ ______------ Di ____ -------Len Length of each line---- 0-_---------------Width of trench._�9�-..--------------- ---- Number of lines_-,-------�-------------�--- 9 � ,, � Depth of filter material_a�___.____. - ---Total length-_____ ____ C Type of filter ma"tenaL-�-4_Ce).0-_---- p Seepage Pit: Distance to nearest well___._______-_____Distan " rom foundation_._-/0.....----•.Distance to nearest lot line---z� ❑/. Depth f Number of pits--------------------Lining material__:__ jt-_C,& Diameter__. I Cesspool: Distance from nearest well____._._.___.__Distance from foundation-------- Lining material_..__ al 1771 Size: Capacity---------------------------- l Size: Diameter.- �--- ------------------------------Depth----------------------------------------------------- gs. ? d Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line ----- -- - ----------- ----•----- -------- ------------------------------------------------------------ Remodeling and/or repairing (describe)--------------------- ---------------------------------------- ' -- ----------• : �l --•------------------- I ------------------------------------- - ------------------ "----------------------- ------------------------------- --------------------- _- - ----------- ----- ---- ----------------------------------------------------------------------------------------------------------r--------------------------- ------------------------ I hereby certify.that I have pr`4pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule n`d r ation of a Sa Joaquin Local Health District. t (Signed)------ ---------------------(Owner and/or ContractorI `'---- -----� --- -- ------ - ----------- - --------- ---------- ---- ---- -- --- - - ---------------------------- --- ---------------------------------.-- -(Title)--------------------------------- ----------- - - ---- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 3 DEPARTMENT USE ONLY / j ------------- ----- DATE-----f 0-. -------------------------- APPUCATION ACCEPTED BY------.-.--- -- - - - --- - - - - ---------------- E . --------------------------- DATE------------------------------------------------------------ REVIEWED BY --- -- ----- - ----- - AT BUILDING PERMIT ISSUED D -- ------- ----- DA : Alterations and/or ecommendations:------. � ` � " �'` ►� ° '�' -' ------4., ---- <(2e-C.s---- �1 ]'� d rr �t �'/,��(�- �.� r ------ t.��►1E---.cam- 4-c� � �f -- lu-e - rnt / /F --- FiNAL INSPECTION BY:.....- --- -�--------- --------------------- -;-- F Date---- g...:/�JO.-€}----• ------ ---� ----- ------ ----------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT ]b01 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.CO. [t -