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FOR OFFICE USE: <br /> ------------------------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------ - ---- . (Complete-in Duplicate) <br /> Date Issued <br /> .............. .------------_`. This Permit Expires I 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.A F <br /> JOB ADDRESS ANp OCATION -------- eat• . <br /> -------------------- <br /> Owner's Name. . . - ------ ------------ • -----.- Phone---------------------- <br /> Address. •----....----` - --------------••----- --- ----� -=-.---- ------------ - ------ --+----••------------ -----------------------------------------......---• <br /> Contractor's Name.-• -s Y.l.��-a�,/�' ----- - ----- ----------------------------------------------- Phone-----. -----------------•- <br /> Installation will serve: Residence. P10' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms Number. of baths-./--- Lot size ----- --- ----------------- -------------------------------- <br /> Water Supply:' Public system [Community system'❑"'Private ❑"`Depth"t `Water'Tabl'e"_"_�'ft <br /> Character of soil to a depth of 3 feet Sand C] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe E] Hardpan E] <br /> Previous Application Made: (If yes,date__._.-------- ;No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sepfic.tank or cesspool permiited,if,public sewer_is-available,.within 200 feet.)___.,_ <br /> Septic Tank: Distance from nearest well------ Distance from foundation------ ............ Material -------------- ---------- <br /> ❑ No.'of compartments__-------- --Size---------- -------- -----------Liquid dept; --------- ------ --------Capacity----------------------- <br /> D;spos - Field: Distance from nearest well....6,6. --Distance from foundation----/®........Distance to nearest lot line---4�__j------ <br /> Number of lines ------------_/_-=--..-----.-.L-ength_of..each..line------4;P _ I�---,-------Width of trench-.,.-o-- ------------------------ <br /> ----------------------- <br /> Type of filter materiai-- ._-- .:..-...Depth of filter material------- Total length.......SO----------------- - --- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line-..____-_.--__-�,r <br /> ❑ Number of pits--- -----------.-_-Lining maferial---------------------- Size: Diameter.---------------------Depth----------.---------------------- <br /> I ; <br /> Cesspool: Distance from nearest well ----------------Distance from foundation._.._.------.---- ..Lining material_...-__-.---------------------------- <br /> . <br /> ❑ Suet Diameter. -- ----t--- ----- - --- ---- Depth--------- ------ ------------....................:_.Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest welt............................: .... {..`..._._Distance from nearest building---------------------------------- ----- <br /> ❑ Distance to nearest lot line ------- --------------------------------------------------------•--------------------------- --------- = <br /> Remodeling and/or repairing {describe):-----..C� �' ' '.- � — ------ <br /> - i -------------- -- --- ------------------------ <br /> I r <br /> --------------------------------------•----------------------------- ---------- --------------------�;--�-�------------------------ <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, Sfa aws, and rules and regulations of the SanJoaquin Local Health District. i <br /> � r y <br /> A - <br /> (Signed)--------- ------- ----------=-- -- -,.r - and/or Contractor) <br /> s <br /> -- - - -- - ------- -- Title----- ............ . ----- <br /> gY� (Title) J <br /> (Plot plan, showing size of lot, location of syst m in relation to wells, buildings etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY ,) f <br /> APPLICATION ACCEPTED BY F ' -------------------------------- ------------- DATE.- 1`-.Z--?.7(:._ <br /> REVIEWED BY ----- :------------ _—_..__�_.,� `--^' - DATE-------- --•------- ' - <br /> BUILDING PERMIT ISSUED---------------- '--- ---------------------- = --' = iDA•TE--------- <br /> Alterations and/or recommendations:.- ----- -- ---- - -- ------ -- --- - ---------------------- -------------------------------- ------ •------------- <br /> ------------------------------------ -------------------------------- ------------- - - - --------------- - -- -------------------- -------....---------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------•--.-._....-.-..._----_..._--__.-..--.•-.___.---._...._----------------------- - <br /> • ...... - ----------- --------- .._-----------------._.........-----------...--------------------.... -----------._...._---------_..._.-----.__._ <br /> .......................................................................................................................................................... _ <br /> r �7 <br /> FINAL INSPECTION BY:. - ---- <br /> SAN <br /> --SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slockton,California Lodi. California Manteca,California Tracy, California <br /> E.N.9 2M 1-67 Vanguard Press <br />