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{ FOR OFFICE USE: <br /> ----- ----- ---------- ------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> - --------------------------------- --------- (Complete-in Duplicate) A;Ay� Date Issued <br /> _ This Permit Expires 1 Year From Date Issued ' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described., <br /> This application is made in compliance with County Ordinance No. 549. <br /> f JOB ADDRESS AND LOCATION---- _�. �_.__.__--- ---- <br /> k ---- --- ------ Phone----------- <br /> ; Owners Nam�eg ��a ^ee. <! --- <br /> Address._..----Cl °" '' -� --..-..:- ' — ----------------=- - --1-----��......... <br /> i. Contractor's Name--- -_� - ---------------- phone <br /> Installation will serve: Residence IM Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _)_____ Number of bedrooms _3___ Number of baths-1_______ Lot size ____Lp� -- <br /> Water Supply: Public system El Community system El Private Depth to Water Table 3- ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam fj@ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: {1f yes,date-----------:------- J No ❑ New Construction- Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> jYPE-OF_INSTALLATION.;AND_SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well -_____Distance from foundation...'-______Material________________________________________________ <br /> I ❑ No. of compartments- ---------Size------------------ -----------Liquid depth--------- ------ ---- --.Capacity------ ---------------- <br /> Disposal Field: Distance from nearest well-FO.s_.._.._Distance from foundati n_2±�,__..__..-Distance to nearest lot line__-4.. <br /> ks Number of lines.______ _____ ____*--.---=----Length of each line.---- � �_-__.. Width of trench---r�_V..........------___.__.. <br /> Type of filter material: % - Depth of filter matedal____j-9---___.___.Total length____9.0__-_________________._____._ <br /> f Seepage Pit: Distance to nearest well-t"-.________Distance from foundation___. _4_ .___.Distance to nearest lot line--s---..____.- <br /> Q@ Number of pits.-- /--------------Lining material-__..._ Size: Diameter----3 ------ ----Dept h---?-'r------------------ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material--------------------------------- I <br /> [� Size: Diameter. -- -------- ----------Depth-- ---------- ------------ -----------------Liquid Capacity----------------------------gals. <br /> s Privy: Distance from nearest Welk___________________----------________.-..-._-.--Distance from nearest building____._-.__-. _--------_---------------- <br /> -- <br /> ❑ Distance to nearest lot line--------­----------------- ---------------------------------- -- ------------------------------------------------ - -------------- <br /> Remodeling and/or repairing (describe):_�t _ -"/a ^...-- --.x'Le,- f'�; A-; � " -------------------------•----- ---------------- <br /> ---------- <br /> ------------- <br /> ---------•------------- <br /> - ------------------------------------------ ---- - ---------------- <br /> ------------- --------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> � <br /> 4 ere----- -- - ------ -- - - -------- - - <br /> I hby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Couni <br /> ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. <br /> Si ned ------------ ---------- ---- ------------------- -------------------- -_ -- .--...(Owner and/or-Contractor] <br /> ( g ) -_ <br /> - --- ---------------------------- <br /> BY: (Tit e) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B _ ! ------`-----------/--------------------- DATE.- - --- -- ------------------------ ` <br /> r <br /> REVIEWEDBY------------------------------------------- ---------------------------------------------—/ - ---------------------- DATE-------------- ------------- ----------- ----------------- <br /> BUILDINGPERMIT ISSUED----------------------------- --------- ---------------------------/----------- ---------------- DATE--------------------------------- -------------------------- <br /> Alterations and/or recommendations:__...-_- ............... ------_-- <br /> .- ------- ----------- ------------------------------- -------------------- <br /> r - ------------- ------------------------------- ------ <br /> I --------- ------------- -------------- --- ------------ <br /> t <br /> IFINAL INSPECTICN BYs .�Y* ---------- ------ Date_ ._ ` = �r ------------------ - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1�& 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street <br /> t 5lockton,California Lodi, California Manteca, California Tracy,California <br /> E.K.9 2M 1-67 VangUard Press <br />