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_v z . v '15F FICE USE- l -i - Permit No. ��3�j,, APPLICATION FOR SANITATION PERMIT ------------------------ __-------- (Complete in Duplicate) Date Issued -��----� --__-- -,"._ This Permit Expires 1 Year From Date Issued r PP - 1�- A Application is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 2 ----------------------- --------- -------------------------------------------`------- �� --_,... ------ Phone.. - -: -------- r # Owners Name_____ _ I f 4 Address. ` x ; Contractor's Name---------------- --- -- --- -•- ----- - f F �----------• Phone----------------------------------- I I Motel ❑ Other ❑ *' Installation will serve: , Residence Apartment House ❑ Commercial ❑ Trailer C Court Q Number of baths Lot size -�........... Number of living units:. Number of bedrooms . Water Supply: Public system ❑' Community system ❑ Private Deptfi;t0 Water Tablei --' ft. Character of soil to a depth of 3 feet: Sand F1 Gravel El Sandy Loam ElClay Loam ❑ Clay ❑ Adobe Hardpan C1 S"� _ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ �'� Previous Application Made: (if yes,datey��,�f 1 No ❑ Ir TYPE OF INSTALLATION AND SPECIFICATIONS: �� (No septic tank or cesspool permitted-if public sewer is available within 200 feet.)°"°""^' I ti¢ an ; Distance from nearest well_-- _--__.----- Distance, from foundation-------------------.Materia4_._--___'_________.._____._-____.____.._-.-___. iyt No. of compartments Size----- -----------------------Liquid depth-------------------------' Capacity------ ---------------- ----------- i IspCs l Distance from nearer# well................Distance from foundation---------"_-_-_._-.Distance to nearest lot line _-_--.__- 3 ---------------- Number of lines-----------------•----=-----------Length of each line--------------------.--------Width of trench_.----:------_----- yp ---------- Depth of.filter mater.ial-----------------------Total length---------------•----------I-------------- SeeVe Pit: Distance to nearest well_ f ` T e�of filter materia____.- : / �' _ Distance fr m foundation_s_��_.___.-_.Distance to nearest lot line___ _.____. Lininmaterial_. _ ._ --.Size: Diameter__y Depth-.--"-/- ----------- -- ,. Number of pits-------1---------- g - � '4:x_4 ing Cesspool: Distance .from nearest well-----------------Distant from foundation--- L'inui.d Capacity gals. Size: Diameter --------------- ---------Depth- = ------------------------ q p ty----------------------- ❑ ; ' Distance from nearest well______________- Distance-from nearest building 'Privy. ----------------•------ --- ❑ Distance to nearest lot line------------------------------------- ------------------------- -------------------'-------- --•-----------------•-----•------------ ---------------- f Remodeling and/or repairing,,(describe)-------------•--------------•-------------------- ------------ --------- ------ ------- ---- -------- ----------------- -------------------If i ------ --------•----------------------•--------------- ------------..---------------------------------- f - -- ----------------------- ----------=-------------- ------------------------------------------------- - i. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i `ordinances, St # WS, and r Ies and regulations of the San Joaquin Local Health District. Y 1 Owner and/or Contractor) Si ned Y _ s ---- --- ----- _---- --- I - ) ___ t ) " Ti+a._-_--- - (Plot plan, showing size of lot, location of system iri relation to we bu{dings, etc., can be placed on reverse side). # e �r, .,... FOR DEPARTMENT USE ONLY �+ APPLICATION ACCEPTED BY----C--------_ - - -------------- DATE +Q- ' Y ) - ------------------- DATE-------------#-- N------------•- I REVIEWED BY---`---=------------------ ------------ --- ----------- --------- TDATE 1 r --- I---------- BUILDING PERMITr ISSUED------------- ---- - ' �.,.� j; --- -- ---- . �a Alterations and/or recommendations•..___�-------------- ----.--_.--"-_ - _--- -- - i " ----- - --------- - ".r I J ----"------------------- ----- - ----- -------------------- - ------ ----- ' - ----------------- FINAL INSPECTION BY::.--------. Date--------------/lJ. Z SAN JOAQUIN LOCAL HEALTH DISTRICT t ' 124 Sycamore Street 205 West 9th Street 1601 E.ka:alfon Ave. 300 west Oak Street Y Lodi,California Manteca,California Tracy,California 5fockfon,California . ES 4 REVIS£O a-s9 3M 3-'S3 F.P.CO.