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SPR OFFICE USE:�� r • C-�-- ------------ -s~ APPLICATION FOR SANITATION PERMIT Permit No. .__.�..�........../ ---'�_ ------ -------------------------------------- ------ (Comdlete 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 install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION----- ------------------------------------------ Owner's Name_____________ Q___ ---%----- -----------------------------------1-�--- - - --- --- - - ----- ----- -- -- Phone------------------------------------ Address ---- ----------------•-----••---- Address �- �----------- W_1----0--------------------------------------------R Contractor's Name--- ..` Q -------------------------- ------------- ------------- Phone- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---t___ Number of bedrooms_ Number of baths A____ Lot size ��_��__-_____.__________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table _6 ft. _. T Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe-ET—Vardpan ❑ Previous Applicafion Made: (If yes,date j':go—w<w Construcfiion:Yes"P�''l10 ❑ FHA/VA: Yes ❑ Nof!j" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well___'_.__-_______Distance from foundation�Q____-------.Material---lone, ___________ Dull No. of compartments_ --------------------Size________... __Liquid depth_________________________ ------- Capaci ------------------- ----- -------- Disposal F' d: Distance from nearest well--- `_------Distance from foundation______/-vl_.__.Distance to nearest lot EV Number of lines___ -11_____-I _.__ _ ___Length of each line_______ ' j -_ Width of trench. _ _ �/ t r Ij . Type of filter materl'al--- /L- --- _L1l�epth of..filter matertai___ Tata1 length_-_-_- - --�----------------------- See a e Distance of nitarest w '" p g ell_________ _____�Dtstaricg�r m f undat on__ _v+.___�_.Dista c to nearest lot lin Numbe Linin materia}_ __ Size: Diameter-��_...-_____ De th___v�S' yam. ., Cesspool: Distance from nearest well-----------------Distance from foundation..... .-------t.-_ Lining material__._.______________.____.______..___ Size: Diameter-------- ` Depth ---------------------- ---- ----- ❑ p Liquid Capacity gals. Privy: Distance from nearest well--- -------------- ----------------------------._Distance from nearest building-_ ---_------------------------------_---. ❑ Distance to nearest lot line-------------------------------------------------------------------------,I-----------•------------------------------------------------------- r Remodeling and/or repairing (describe] ------- - ---------- FI - Yf -`-�# `' 1r _ --------------------------------------------------------------------� ------------------------------------------------------------------------------ --- ----------- ---------------- -------------------- " ------------------------------------- ----------------------! ------------------------ ---- ------------------------------------------ ---`3------------------------------•--------------------------- __ ----------------------------------- 3l --------------- _ _ I hereby certify that I have prepar this pa p ication and+Naf"f eFi`work`wilI bedone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------------------------------- -------------------------- --- ----------------------------- --------------------------------------------------------(Owner and/or Contractor) BY:-----------------------•-•---------- -------------- ---------- ------- -------- ------------------------------------------------{Title)--------------------- -------- - ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ __- --- --------------------- ------------------ ---------------------------------------- DATE._/2-_`.�2: -r- ---------------------------- REVIEWEDBY--------------------- ----------------------- ------------------------------------------------------------------------------- DATE-------- --- ----------------------------------------------- BUILDING PERMIT ISSUED------- --------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---4- •`l_`�-_4�CK-_-P1 ---------------------------------------------------------------------- -----------------------------------------------------------:------------------------------------------------------------------------------------------ ------------------------------------ ---------------- -•--------- ---------- ------- ---------- --------------------------------------------------------------------------------------------------------------- ------ ----- ---------------------------------------------------------- -----------------f:----------------------- -------------- ---- ------------------ ----------- -------------- -- - ----------------------------- FINAL INSPECTION BY:_"`-° '`: C Date Ir AL1` �' ----- = -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California .Lodi,California"lifornia Manteca,California Tracy,California Y .. F.P.CC.