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APPLICATION ,FOR SANITATION PERMIT Permit No. ___.1Z-___ Complete in Duplicated 3� elf - s_ .. 4 - ' r �. Date Issued Application is hereby made to the San Joaquin'Local Healt District for a permit to construct and install the work herein described. This applicatiori is.macle'.in compliance with County 4V eNo. 549, t--;JOB ADDRESS. A I CAT -------- € ------- -- Owner's Name- ----:1 - .-- ---- ---------- --- ---------------------------------- --•---`---------. ------------ -------------------------------- -------------------- P :------------------------------------ one Address-....... •-------------------- --------- --------------- ------ ---� J"- ---------- - /- � � rea` -- -� -- -- 9�---- ------------Contractor's Na} Installation will serve:- Residence W Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: __-_-:-,Number of bedrooms Number of baths Lot,size __ __ ,* ..� . Wate Supply:' system R Com unify system"❑;.-:Private'❑-Depth to Water Table Character-of soil to a dept f f 3'feet-' Sand ❑ Gravel ❑ Sandy Loam n.' Clay Loam ❑ Clay ❑ Adobe Hardpan.0 Previous Application Ma e: Yes Ej �No \New Construction::�Yes,S-�No,�«�•rFHA/VA: Yes El No 0: . TYPE OF INSTALLATION AND SPECfFICATIONS: / ' No septic tank cesspool permitted if public sewer'is ailable within 200 feet.) � E -gip ..._....�.�er..�.... P .�. ....-. _ ..�....�.. ., . pt; rik: ., Distance from nearest-.well_________________Distance from, foundation___ -___-_____,___-.Material-____________________________-____._______- t f # of compartments----------------------- �ize---- --------�;. ,---:- Liquid depth-------------'- --------r Capacity---------------------- osa Fi d: Distance from nearest well Distance from foundation__----------- _____Distance to nearest lot lirie_____'_________. Number of lines ___=__�.-. Length of each line- --- ------------------------Width of trench------ ---------------------------- f r T • e of filter materiaL -De th of filter material_______________ __.__Total length_______________________________ ., r ,�... ! `. Seepage Pita Disance to nearest e!I_____________ Distan m f ndation__ d:-_._-,Distan�e to nearest lot Number of pits______:-__.-__'_-_Lining material r__.Size: Diamete'r__.c ti3'_____--___-Depth__. foundation- - --1---..Lining material.- -------- w i Cesspool: ' Distance from nearest.well- DsFanceafrom, Size: Diameter-------- - Depth--------------------------------------------- --- ---�__Licluid Capacity_ --gals. Privy: Distance from nearest well-------------:Distance from nearest building_________________ _________ _ _______ 1 ------ �� . ------------Distance'to'nearest lot Remodeling and/or repairing (clescribe):--------- - _ ------------- -------=----------------------=-- ------------------------ -----------•-----------------------------. r r >i. - ------------------------------------- -------•-- •---- ------------- ----- ------ -------- ------- - --- - ••------------------•----- - r. - �. - ' - I-k-.-.9 s I g - , - -- - - --------•------------------ k------------------------------- ' 1 hereby certify that-1-have prepared fhis-application and'fh-a,-ihe work will beodone in accordance with San Joaquin County ordinances, a laws, an)doles; and regu tions of Aer-San Joaquin Local Health District. (Signed ' '�^ -------------------- ,• - Owner and/or Contractor) x e ------ - - , i --- ----- --- ---- -- --- !•- - ------ By: ._._Title • (Plot plan, showing'size of lot, location of sysfe n relation't" wel s;'buildings, etc., can be placed on reverse side). ' ` + FOR DEPARTMENT USE ONLY" APPLICATION`ACCEPTED BY h } �f....................... j--------------------------- DATE----- = rt ------------ ---- ---- REVIEWED BY---------------------------------------- - :---- ----- ........ --------- BUILDING ------- - �_ DATE ___ BUILDING PERMIT ISSUED--------=---------' L = '= ==_ = = = - : DATE---------------------------------------------------- i - Alterations and/or eco' msndatians. - - = = «_... / � . r - _ )---------------------- �a ,s , ;� ' �_` _" ; '� 1 •J�, r�` I � 1d------------------ -----------------------------• ---------------------------------------- ------------------------ --------------- ------------------------------------ _______________________________________--------________________________________________________________________________________________________________________________________________________________________________________ _____________________________________ _____________-__-.-_----------------------- ------------I-------------------------- _ __ -_.,.--_-____--_-_____________ __--__. - _ - ._ FINAL• -INSPECTION`..BY::-'-__ .- --- =----==- — ..Date--- _ --- "--------"=-:------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P,CO.