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-- �FOR FFICE�� -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .................... -------------- ---------- ------ (Complete it Duplicate) (Q This Permit Expires 1 Year From Date Issued Date Issued �--- Application is hereby made to the San Joaquin Local Health District for a permit to co/jstruc and snsll the w4lkber�e This application is made in compliance with County Ordinance No. 549. ��[/j � CJ '� �/� O A - ES AND •�- LOCATION AT^ � t � --- �� r-""rte �`e�-Q��rx*r>�GZ.' __----- JOB ADDRESS ASN.DyLOCATION_____.AL-__________ _ �(J Owner's Name..... .Gl.. �_.__i ----- ------------- Address -•----••-•- Phone..... a Address ;.. ..�. .. - ----------------------------•---1---------------------...-----•-•-•--------------•----•---------- Contractors Name.. F- ----------- s - a,s�1�. ----�' � �---- ------ - Phone-- ...... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other C. Number of living units: ..0_ Number of bedrooms _.0__ Number of baths' 'Lot size ......�..D.g)_.:_____-. Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to ater Table -------- ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan C]1 Previous Application Made: llf 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.))Q f Sep�Ta . Distance from nearest xilsQ_Q__if___Distancefym fou Ptlon.__`Gl.....__Material............................... ............... No. of compartments_ ____________________Size _�____[P._ ��,_._Liquid dept h____S r............Capacity................Q Disposal Feld: Distance from nearest well o.__Distance from foundation___-*3-_0.......Distance to nearest lot line........... Number of lines_______-Z______________________Length of each line.... �_ __.__---- ---------- length_-�j0.0-- '................ (j Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line....._ _...__ ! ❑ Number of pits----------------------Lining material--------------•--------Size: Diameter---------------------- Depth---------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_.__-_-________.Lining material------------------------------------- ❑ Size: Diameter--.-----:---•-------------------------Depth----------------------------- ---------------------Liquid Capacity----------- ...............gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_--__--..___Y__.�----------------------- Distance to nearest of line_..___._____.__________ Remodeling and/or rep--a--l-ring (describe)------ - ----------------------- - -- ------------=-- ------ -- -------------- - ------------- 1 -------- - - ---- ----------------------------------------------- 41 --- ----- ------------ --- - - - - ---- + --------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate la g uin Local He th District. and rule and regulations of he San Joa ��e _ --.__.._-____. Contractor (Signed .. ' ) f �. 1 By:___---------------- --------------------------------------------------- ------(Title)----------------------------------------------- --------------- (Plot plan, showing size of lot, location of system in rela n to wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- DATE ,�-.._Z-� .._- 1 REVIEWEDBY----------•=------------------•- ----------------------------------------------------- DATE -----•-•-•-•--•------ ------ BUILDINGPERMIT ISSUED...................-----------------------------------------__................................... DATE-------- --------------•---------- ------ Alterations and/or recommendations:----- -----------------------------------------------------------------------------------------------------------•-----•------------------------- ........_.............................. ................_... ----• ---.-- -- -------------------------*......------------*---------*---------------------------------------------------*--------- HNAL INSPECTIONBY------ ------ --- ----- Date �/ r ?� ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak street 124 Sycamore Street 205 West 9th Street -IN Stockfan,CaliforniaLodi,California Manteca,California Tracy,California J *t' E8 9 REVISEb-.8_59 yM-5-61rA A8 ''E•G4M - :� rp:.-. k.