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FOR OFFICE USE: ~ � r APPLICATION FOR SANITATION PERMIT Permit No. . ..........3 �� ...•-_---- ------------------- --------- [Complete in Duplicate} __"-- Date Issued - ------ ..... ----:.......___------------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and &stal4 t e work herein described. This application is made in compliance with ou ty Ordinance No. 549. JOB ADDRESS AND LOCATION ...... .._..�_c' �17�1911 ' �q'lp dtr � / �cl fp��=�P[P�• l ' � P�-l -:V --------------•--- ------ ------ --------------- Phonel-".� b 5 Owner's Name_-___-_ __ .._ Address -7 .,-� --.- ' + l; `----,-------- -- -- -,p -k7oA Contractor's Name---------••-------------&WA2-V�-.•-• ----------------------------- -----=------ -- - -...---------- ------------- ------------ Prone------ ---------------_---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Uk Motel ❑ . Other ❑ Number of living units: J- Number of bedrooms . -. Number of baths 461' 1'ftpe -CF------------------- ----- Water Supply: Public system ❑ Community system .❑ Private X Depth to Water Table�Q_ ft ,/ I Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy:Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Pp Previous Application Made: {lf yes,date--------... ...... } No New Construction: Yes ❑ No E] FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Tank: Distance from Dearest well---- ...._ Distance from foundation feet.) 1 No septic tank or cesspool permitted if public sewer is available within 204 / } - -- 0- . Material p , No. of compartments----------- -----------Size---- - !- -- -----------Liquic(depth.-.- --- --------Capacity----- j Disposal Field: Distance from nearest well__"_'P4----Distance from foundation__._/p.........Distance to nearest lot lire---x----_._-. Number of lines---------- �__- Length of, line_. '_ : A--......_.Width of trench_-__ 2-,/ __________________ Type of filter material_ t -._ &epth of filter materiaf__ .../_ ..�---.Total length"_____/�_jd--------------------------- �] Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line--.__...--_-__.._ • r [] Number of pits--- ---------------- Lining material ..-.------- Size: (Diameter--.--------------------Depth-------.-.----------------------- Cesspool: (Distance from nearest well ----------------Distance f rl foundation... ..... ...... ..Lining material-----------------------.._..._------ i f ❑ Size: Diameter- -- -------- ----- ---------- Depth----------- --------"........ ------------------Liquid Capacity-------------------- -------gals. Privy: Distance from nearest welt-__-_-._....-.-..---________-------____ ___---.-Distance from nearest building--__.___-.---.-..---.-------..._..._ ❑ - - ------------� ------------------ -------:------ ----•-------'------- --- - Distance to nearest lot lin�e/--- -- - ------ -- ----------- - -- --------�-----�- -- �f/°j�---"---------•---------------• Remodeling and/or repairing (describe):-_ _ � sur`_...._ ' { - _ ((((((I��!!f!!! — -- - --------- -- -----------•-••----- ----------------- - -------------------------- -------------------- --------- ---------- ---------6�_--- --�"a�----- �------1�---�7-- -------- --------------------------------------- ------------------ ---------- --------------------------------------------------- ------------------------------------------------ I hereby certify that I have prepared this application an t a ie wor c wt a one in accordance with San Joaquin County ordinances, State laws, and rule and r gulations of the San Joaquin Loc al Health District. --..--_-._---------_---_-.-Owner and or Contractor ------ (Signed)------ t, ------------- ------- (Owner ) 6 gy:-------------------------------- -----------•---- --------------------------------------- --------------------------- (Title} (Plot plan, showing size of lot, location of system in relation to wells, buildings;'etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--*�FbR `-------------------- --- -- --------------------------- -------- - DATE_ - �_'- JBREVIEWED BY------------ -------- --- ------------------------------- ----•- ------------------------------ DATE------ ----•-------------/ ------------=------------- BUILDINGPERMIT ISSUED-------- ---------------------- ------------------------- -- -------------- DA-TE---------------------------------------- ----------------- Alterations and/or recommendations.----- - - ----------------------------- - --- ---- -------------------------------------- --•------------------- I` ------ -- ---------------------•- -- ----------------------------------- --- -------------- --- ------------------------------------------ ----- - ---------- ---------- ----------------------- -- ------------------------- - - ------------------------- --------------------------------------- -----------------------------------------------------•----•-------------- FINAL INSPECTION BY:. —�. --¢-.. ..L L �1 .�_ r Date- . `=f��=�' . --------------------------- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r' Sloekton,California Lodi. California Manteca,California Tracy,California C,�.� E.H.9 2M 1.67 Vanguard Press � *^• (j�