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FOR OFFICE USE: }. - IM APPLICATION FOR SANITATION PERMIT Permit o. :. .._ ._ --------- -- ------------- --------- - ---------------- (Complete in Duplicate) Date Issued _-------------------------.-__.__ This Permit Expires I Year From Date Issued Application is hereby marl'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 Ordinance No. 549. -C� A� JOB ADDRESS AND LOCI TION�a'� _ .P�- .f_ �I °'1 ° - ` M• �� i Owner's Name - ----- - Phone. Address--- 7TI`` " ------•-• ----------------------------------------------- ---- -- --------------------•-------------- '�x 7 �. ---•--•. Phone : Contractor's Name ---- ----- I-- 1 Installation will serve: Residence Apartment House ❑ Commercial [_1 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Number of bedrooms _ Number o baths._Z--- Lot size _1-11-1_. _..____ __ ____ ______ -- Water Supply- Public syst�m El Community sys m E] Private Depth to Water Table -------- ft Character of soil to a depth of 3 feet• Sand v Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ I Previous Application Madel Ilf yes,date-------..-.,------- ) No ❑ New Construction:,.Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distancl� from nearest weal------------ -Distance from foundatioq_.___----_---.__...Material _-__-_______P._....____-__-_----------_____. N 1 ❑ �,,Id- Dotancl� fopmrnea est well-.,��.._Dstance from foundatioin ui�� th- �lstance to nearesacity______.___________Len th of each line-_ .___' : __:..Dispost lot line__- _______._.. Numb6i- of lines.----------- g Width of trench.-:. -- ------ € Type of filter material-_. p 9, �f i tance to nearest well_.__.t_____ _________Dstan effrlotmrfoundatilon./ _"-._.__..Distance to nearest lot --- -- �'" Seepage Pit: D s t lot line_________________ �f ❑ Numbe.1 of pits.- ----------------- Lining material-----•------- - ---- Size: Diameter.----------------------Depth:` Cesspool: Distance from nearest well ----------------Distance from foundation_________________ _ Lining material...................._-_._.________-_. ❑ Size: Diameter- -- --------- ----- ----- _.Depth------- -:----- ------------------ ----- Liquid Capacity- ------------------------gals' �€ Distance from nearest building Privy: Distance from nearest well :. = 9 e ❑ Distance to nearest lot line --------------- - - --------- ---------------------------------------•- ------------------='---------------------- ---- --- I� i Remodeling and/or repairing (describe :__-_...._.__--- -- --- - .--- -------------------------- - -- -------- -- I - - - - :--- r---------------------- - ---------------------- ------------------------ ----------------------M-------------------------------------------------------- --- --------------------M-------•--------------------------------------------•---------•------------ ----- ---------------------------- I hereby certify that Il have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws d rules and regulations of the San Joaquin Local Health District. a�LLIls, --: ------------- ------ ----------- ---- ------- �-:end/or Contractor) f (Signed) l By:------- — - ------ - _-----------------------------(Tit e)---- --...------- - -_ (Plot plan, showing size of lo+, location of sbuildings, etc., can be placed on reverse side). .r FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-- -------------------------------- ---------- DATE--.1.�'------- --------------------- REVIEWED -------------------REVIEWED BY- ------------------I°-------------------- ------------------•-----------------r------- -------------------------------------- DATE----- ---------------------------------------------------- BUILDINGPERMIT ISSUED-------- -- ----------------------------------------------------------------------------------------- DATE----------------- ------- ------------ --------------------- Alterations and/or recommendations------- -- -------------- ------ --------- ------------------------------------------------------------------ "------ -• .---------------------------- ---------------------- -- - --I�-------------------------- ---.----- -------- ---------- --------------------------- ---- ----- ----------------------------- --------=----- ------. ---------- I I(: ... --------------------- -------- -------- "--------------- -_------------- ----- - ------ ------ FINAL INSPECTION BYIII: .//�' _ R _---..___ Date .._T !/ - : SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Are. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi. California Manteca, California Tracy California Stockton,California� Y, E.H.9 2M 1-67 Vanguard Press