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JF,/O[R OFFICE USE: !� 'T// �/] .__. iF-J-----------------" :_e�.4!. �J , 1. y A- _------- APPLICATION FOR SANITATION PERMIT Permit No. -),--...__---_ . &I (Complete in Duplicate) 'Z ------------- ------- ------------------------------- This Permit Expires 1 Year From Date Issued Date Issued . .r 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 OrdainnDance No. 9- JOB ADDRESS AND LOCATION... /CL �/__--- _C;� ------ -- -------- "` Owner's Name r 1 ( - -r�r---------------------- - - -------------------------- ----- ---- --- Phone-- -�_��Q . Address-----•------------------------------••- f6--- y I--------sav r-*-----_:_bAj ja ---------------------•----------------------------------------------- ----- - ----- Phone-11_4S ! &R 7 Contractor's Name Apartment House E] Commercial Commercial Trailer Court E] Motel Other E]Installation will serve: Residence X. i Number of living units: __- ___ Number of bedrooms_."Number of baths __I____ Lot size ` __ -_-_!_7r.f�__----------------------- Water Supply: Public system Community system ❑ Private,❑ ,Depth to Water Table4ft: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-E] Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y ' Septic Tank: Distance from nearest welL_____t-_-___---_Distance from foundation--------------------Material_-_-________._______------------------------------- ❑C7><c544AXI'No, of compartments--------------r.........Size------------------- -------- ---Liquid depth------'--;------------ ---Capacity----------------------- Disposal Field: Distance from nearest well/IfE�C4 _-Distance from foundation-10.-__':-___-_.Distance to nearest lot h,e___IS' ____. Number of lines___0 �-._--_Cf� Length of each line__,? _____ kz�__.Width of trench ____ _--___ ---------- Type o'r filter material__ -_ a�R _De th of filter material__-.�__�_S-�_-__-__-Total length___._ :__ + G Yp +�------ p Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___`.:: ❑ Number of pits----------------------Lining material------.------------. Size: Diameter-----------------------Depth---------------------------- Cesspool: Distance from nearest well____--__--_---__Distance from foundation------------- ------Lining material---------------------_____--_________. ❑ Size: Diameter---------------- ---------.Depth------------------------------- -------------------Liquid Capacify..--------------------------gals. V) Privy: Distance from nearest well-------------------------------------0-----:-- -Distance from nearest building----_____--_______---_____---_-------- ❑ Distance to dearest lot line--- ----------------------- - -------------- -------------------------------------------------------------------------------- ------------ Q I. Remodeling and/or repairing (describe)=-- ------ ------------- ---- --------- --0------------ '► ---- -----------••--------------•-----------------------•------------------- --- _ f ----------------------------- ------------------------------------------------------------------------------------•-•----------------•--------------------------------------------••------------------- -------------- 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, an s and regulations of the San Joaquin Local Health District, (Signed)------------------------------ ` -------- -- ` -------- ------------------------ ------(Owner and/or Contractor gY -----------------------_--- (Plot •_{. .� - -- -- ----------(Title)--- '-- ------- - ---------- Plot Ian, showing size of lot, locat�system in relation to wells, buildings, etc., can be place on reverse side). ( p FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY------------C-;/a---------- ----- DATE-'-. = ' 6J- ------------------- REVIEWEDBY------------------------------------- ------- - ------------------ ------------ ------------ ---------------------------------- DATE------------•----------•---------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- - -------------------------- --- DATE-----------------:------------------ --------------------- Alterafions. and/or recommendation :----------------------------- - ---------------------------------------------------------• -------•---------•-------------•------------------------•------ --------- _ ` .0/e, ------ ----------------------------------------------------------------------- ---- ---------------------------------•---------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----,.c-,e- ---------------- Date.... �� 'G s-------------- ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT I1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockfon,California Lodi,California Manteca,California Tracy,California F.P.0 O.