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OR OFFICE USE: APPLICATION FOR 'SANITATION PERMIT Permit No. .1_....................� ; _. .�_--g_` --- ------ ------- az-=--- _ ----------------------------------------- (Complete in Duplicate) /a� { -___.__-.--_ This Permit Expires l Year From Date Issued pate issued y: 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 Or�inance No. 54 JOB ADDRESS AN L CAI N � / �i -- -------- -- -- --------- q - ------------- c/ Phont `- --- Owner's � Owner's Name----- 4------ --- --- -------------------- Address-----•---------- a -------------- ---- - --------- -- ------ ---------------------C�----------- jJ " ----- Contractor's Name_ _ - - Installation will serve: Residence 0 Apartment House [_1 Commercial ❑ Trailer Court ❑ Mote! ❑ Other Number of living units: __ _.__ N ber of bedrooms __/-- - ._ Number of baths _ Lot size _;,74 ------ -•--/- ------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe hardpan E]Prevlaus Application Made: (if yes date....................f Na F1 New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septi or cesspool permitted if public sewer is available within 200-feet.1 I S j Distance from nearest well_________________Distance from foundation-------------------.Material--------------_`_______._______---._-____---__. .o.;of compartments---------------- _Size--------------------------------Liquid depth---- ------------------- :Capacity p - i N 11�� 5k1� - Distance to nearest lot line---�.10_-_. Is osal F Id: istance from nearest welLe'4--_ .____Distance from foundation___'___ ___---_ Number of lines_____ ._ _ Length.,of each li�e___-_. ___Q_r-[- ----Width of trenchfin ----Total len th---------- ------ ----- Type of"filter materiel`?- ---Depth of filter materia___-.-�_ -____ 9 �,Distance from foundation__/ n _Dist cejo nearest lot ___� ------ S a -"_._Sea e Pit: Distance to nearest well___]..___)__.- " Number of pits----I----------------Lining material_- _____.Size: Diameter___s __..__.Depth_ �.t Ces pool: Distance from nearest well-----------------Distance from�undation...._.___----_ ___.Lining material_..-__ _________.__._--____.______. Size: Diameter------------------ ----------------- -Depth----------------------------------------------- ._Liquid Capacity------------------ ---------gals. Privy: Distance from nearest,well______________________;--------------------------Distance from nearest building ri._.-.------------------.--------------- ❑ Distance to nearest lot -{ ----------------------------------------------------------------------------------------- f Remodeling and/or repairing (describe):--- ---- ---------------------------------------------•. --- ----------- Au,,t�- .: --------- _ ------------------------------------ --- { ------ ----- -------------------------------- --------------------------------------- 1 hereby certify that, -ave prepared this application and that the work will be done in accordance with"San Joaquin County ws ` ordinances, State la , ules and regulations of the San Joaquin Local Health District. ` Si ned 2"`V & nigla Contractor) St;PT1C"" _RVICE ---------- ---------------------------------------- TA.14K By. 2915 6_Miner Aver, #iQ__6.3847 ------Irelan - --- ----------------- --- -----------(Title)----- - -------------------------------._...- -------------- (Plot plan, showing size of lot, location of system wells, buildin s, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ------------------------------------------------------ DATE -.T - � REVIEWEDBY-------------------------------------------------------------------------------- ---------------------------------- • DATE-------- -------------- ------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------- -=---- DATE------------------------------------------------------------- Alterations and/or recommendations------- ----------------------------- ------------------------------------------------- ------------•--------•- •----••------------------------------ 1� -- /°,,�;�`��-�►--- -�-------°'fit---- ---- - ----- C. ----------------------------------------------------_------------ -----•------•--------------•----------"------ - -�-�5 ---- -- ---------------------------------------------------------------------------- - ------------------- ------------------------------------- FINAL INSPECTION BY: �" Date-- -------`� � r------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20S.West 9Th Street Slocklon,California Lodi,California Manteca,California Tracy,California F.P.CC.