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FOR OFFICE USE: <br /> - -- ---------------------------------------- -- ----- <br /> ------- <br /> --- <br /> m • _ --_._-"- --._----_--- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------- ------- � �. <br /> ------- -- ------------------ - ' -' } [Complefe•in Duplicate) <br /> --------------------------! "-- This Permit Expires 1 Year]From Date Issued Date Issued .. -.� _- <br /> 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and installthe work herein descried. <br /> This application is made in compliance with County Ordinance No.%549. <br /> JOB ADDRESS AND LOCATION- <br /> � <br /> j <br /> -- -- <br /> Owner's Name---- <br /> Address <br /> ame---- <br /> Address---2_0� _ _ _ Phone_�,5_ 7-T141- <br /> ------------- <br /> -T <br /> �-�----- ------ -•---- <br /> - --- •-•------- ---------- a-------------------------- <br /> Contractor's <br /> _--------_----_ _-_-_-- <br /> Contractor's Name QW_l _ _ _-------•------ ------------- --------------------- ------- - -------------------------"----- <br /> - • •----- .- Phone-------------------......."..--..- <br /> Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other (] <br /> Number of living units: -- ----- Number,,of bedrooms I--"- Number of baths 1---- Lot.size ----- , <br /> Water Supply: Public system Community system ❑ �rivate� Depth to Water Table'Y�-�ft <br /> Character of soil to a depth of 3 feet- Sand A—Gravel El Sandy Loam❑ Clay Loam E] -Clay [❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-------------------- No New Construction. Yes ❑ No �_ FHA/VA:.Yes ❑. No [ <br /> iTYPE-OF"INSTALIr4Tf0'N—ANDTSPECIFICATIONS: - � - - - <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> - <br /> Septic Tank: Distance from nearest well--- "---Distance from foundation-J.0_--___.Material <br /> ��yyyy No. of compartments-- __.__.,___Liquid depth__-,` _ -__._ Capacity__-;�.�_____ <br /> Imo'` P - - ------------Size-----•---------- <br /> I Disposal Field:,, Qistance from Weare t well__ ----Qistance from foundation...<--- ...-.-.Distance to nearest lot in��-� <br /> ( _ Number of fines "--_" __.-_ -.-'_-_- _ -_L ngth of eachline-- �"i)..Pf Width of trench".- .. :_ <br /> ---------------- <br /> -_ - th of filter material--�__.._ length--- ' <br /> S Type of filter material-� Total �- ------ ----------"-- <br /> eepa' Pit: IJ,istance to nearest Distanc `from`fo da 'on. .__ ane tp nearest lot iine-�d_-� rt <br /> . ,.: Number of pits.-- .__ .------_..-Lining material _ e: Diameter._" Depth__ f .. -_ _ <br /> ..---------- <br /> Cesspool: Distance from nearest well --------_----- from foundation----------------- -.Lining material--.____----_------------"- "_--_. V <br /> Size:,Diameter. "_ -- Depth ----------- _- ----------------Liquid Capacity ----- -- -------- 9afs. 1 <br /> Tom,. --- <br /> -,..� <br /> Privy: Distance from nearest welt.... ...Distance from nearest buiidin'g "'rwis� <br /> ❑ Distance to nearest lot line .-.-"-"-"-----.- -_ - <br /> ---- <br /> - -- <br /> Ll A <br /> Remodeling and/or repairing (describe)----------- .vA/` _ fes-•_: A"..�� ; <br /> ------------------ <br /> ------------------------------ <br /> - - <br /> } . i <br /> - --�'a r <br /> ---------- --------------------------------------- ............................ <br /> 1 =----I`d------- <br /> -------- <br /> F-°C1 ST!- S ST :/L*� <br /> ----------------------------------- --------------------------- ----------------------------------------------------------------- ------------------------------------------------ - ------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,'and rules and regulations of the San Joaquin Local Health District.. <br /> 9 <br /> [Si Wed <br /> �) - = - -- _----------- <br /> - - : ~ - _-- - ----------=-_------- =__.=(Owner_and/or..-Contractor)By:------------------------------------------- -------------- -------------- -------- ------- -----------(title)........., -" ............ -"-................ r-------- <br /> (Plot plan, showing size of lot, location of system in relation to-'wells, buildings, etc., can be placed on reverse side). <br /> FOR E'ARTMENT USE ONLY <br /> 4 APPLICATION ACCEPTED BY---- �. '-- DATE_­_:- <br /> �_C ------------- ----------------------- ------------- DATE •J--ZCo — s <br /> -- ------------------- <br /> REVIEWED BY---- --- -------------------------------- - - " ------ ------------------- ----------------------------------------------- ------------ <br /> BUILDING PERMIT ISSUED-------- ---------------------------- --- ---------- DATE------------------- <br /> --------------------------------------------- - - <br /> Alterations and/or recommendations:-----.--,-------- ---------­----------- - --- -------------------------- ----------- I " <br /> ------------ ------- ------------------------------•------- -- ----------------------- --------- ------------------------ • - <br /> ------------------------ ---------------------------------------- ------------------------- -------- <br /> -------------------------------------- - ------ "- - - - -- --- ---------- ------------------ ------ <br /> --"---------- <br /> BY:-FINAL INSPEC <br /> i <br /> K------------- ----- -- Date--- -------- 2-7--_-.6-------------_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 1:.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stacktanr California Lodi, California Manteca, California Tracy,California <br /> E.H.9 2M 1.47 vanguard Press <br />