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-r �------------------ll--3- 4 -------------- ------ APPLICATION FOR'SANITrATION PERMIT" Permit No. _c 4_:: ----- ------- -------------------- ---�----- (Complete in Duplicate) This Permit Ex Tres T Year From Date Issued ---- - -- Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in the work herein described. This application is made in compliance with County Ordinance No, 549. I JOB ADDRESS AND LO ATION_._._ Q__� t� ----------------- wner s ame.._-_._- -- -----•- -- ------------ Phone-------------- - --------------------- ress.------ ---------------�_', - -- -------- ------ -------------------------------------------- •- •-------------------------------- Contractor's Name........ .. ... G�-- -- - ---•--------- ------------------ Phone.--�-�•---- --f4/L - ------ ---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer, Court ❑ Motel ❑ Other ❑ Number of living units: "__'Number of bedrooms Number of baths-/—Lot size Water Supply. Public:system stem --- -""-"------------------------ PP y� y ❑ Community system ❑ Private ER-tepth to Water Table ��_ ft. I}}I Character of soil to a depth of 3.feet :.Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [3 Clay El Adobe ardpan ❑ I Previous Application Made: (if yes,date------------- ] No ❑ New Construction: Yes ❑ No [i FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e tie . Distance from n11 earest well-----------------Distance from foundation-------:------------Material-- -------- ------- --------- --------------- o. of compartments---- ---- --- -----------Size--------------------------------Liquid depth------------ -- ---- --Capacity-- -------------------- I . pisposalI: Distance from nearest well-_ d_-----Distance from foundation__�'d_ __� ' Number of lines_______ ___________ Length of each line.___..._ -----------Distance to nearest lot line.. _______•• 9 Width of trench.._. ------------------------ Type,of._filter material_"V/- ,W4'__Depth of filter,material_ -� 4�-1-� --------Total length- ------- ----••--- ---------------� Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line."._-..__....._. ❑ Number of pits--------_-------------Lining material..__-.---------------- Size: Diameter. --------._.Depth-----------------•- ------------ esspool: Distance from nearest well-----------------Distance:from r foundation_________________ _ Lining material--------SizeDiameter D ---------------------- --------- p --------- ---- Liquid Capacity ---------------gals. Privy: Distance .from nearest well..__...-__"____. Distance from nearest building-, : i - --------------- g------------------------------------ ---- ❑ DisMn`e to nearest loft line_______________________-____ I i Remodefing and/or repairing (clescrii e):__- ------- ---- ) " Y 1 -------- ---------------------------------------------- ------------------t------------------------ ---------------------- ------- ---------------------------- ------------------------------------------------------------------ -- ---------- - I hereby certify that i.have prepared this application and that the work wi11 be- d--o'-n-_e--in accordance with San--J-- oaquin County ordinances, St laws, and rules and!reg tions of the S Joaquin Local Health District. (Signed)-------- --- Z (Owner and/or Contractor) 1 Title Plot plan, showing size of lot,.locatio y B )- __ '; 9 t of s stem in.relation to ells, buildings, etc., can be placed on reverse side). d FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ----------------- I--------------------------- REVIEWED BY >3- QATE.- S $ ------------- ---- ----- ----- DATE------- BUILDiNG PERMIT ISSUED ... ----- ------------------------ - --------- DTE i - , Alterations and/or recomrn ndations:.-* " .. �... .+w �.. t �3� - -----------•-------------------------------------------------------------------------•-----------------•---------- y � I ..................... .ti---' ------ .................................... -------------------------- _-------...---_---' ................................. .............. ' FINAL INSPECTION BY:.. S13la ( ---- - ate-- --------- -------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West oak Street 124 Sycamore Street 105 West 9th Street � 5locktan,California 1 Lodi, California Manteca,California Tracy,California F.F.C O.