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i 1 11 APPLICATION FOR SANITATION PERMIT Permit No. �` (Complete in Duplicate) 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 LOCATIO -- ---R_ -- ------- ------- - - - - ----------- -n---------------m---------�-off.`-`C=-I,0 Owner's Name // - ------------------- ------------------------------------------- Phone ------------------------------•---- Addressw ---------------------------------------------------------------------------------- I� -----------------------------.... Contractor's Name--------------- -------------- .... ---------------------------------------------------------------- PhoneF--------------_------------------- Installation will serve: Residence UKO'A"partment House ❑ Commercial ❑ Trailer Court ❑ Motel E]:; Other ❑ i Number of living units: ___ Number of bedrooms J. Number of baths __l__ Lot size _,A 7---------------- Water Supply: Public system ❑ Community system Up--Frivate ❑ Depth to Water Table .+ft. II Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®"'H'ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes g?—No ❑ FHA/VA: Yes ?4—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) I` s IIIA Septic Tank: ------ No. istanearest wa "'rD stance fromfoundation_ i _�--_---_- Mara�-_- L oof compartments_ � elq�dPth � Pacity- Disposal Id: Distance from nearest well____"~"'.._Distance from foundation------/$K--------Distance to nearest lot N Number of lines--------a_�_-- ____-- _ 'r--- f trench-_-9..____. Length of each line___ AO_ _,________.Wid#h of trench_ ___________ ______ _ I� Type of filter material " Depth of filter material____/___ ____.Total length_____, p_ � 'f�__.D' tante to nearest lot Isn _ { Seepage t: Distance to nearest well------ •--,.______Distance from ---aw fe Number of pits-----�----__---__Lining material__ � _Size: Diameter---&.3 ........ Dept``h_ '_, / i Cesspool: Distance from nearest'wel[________________Distance from foundation--------------------Lining material-il_ ___ __ ----------- Size: Diameter--------------------------------------De th-------------------- --_----Li uid Ca acit�l als. ❑ P q P Y---------------------------9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------I--______________________________.._. ❑ Distance to nearest lot line ---------- ------------------�M---------------------------------- h �NRemodeling and/or repairing (describe)-------------- _ J __- ------ II i ------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- � , I hereby certify that I have prepared this application and that the work will Ise done in accordance with'iSan Joaquin County F ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed)------------------------------ ~ - ----------------------------------------------------------- IIS Contractor) r --- ----------- - -------------- -- --- ----- Title-------- (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be place on reve icsehside). FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY----- ' '---------------------------------------------------------------------- DATE--------f -h- -- ---------- ------------- -- ---------------- ,- DATE----------------------- ----------------------- REVIEWED BY----------------- - ------------ - ------------------------------------------------------------------ -- - BUILDINGPERMIT ISSUED------------------------------------------------------------–-------------------------------------- DATE------------------- �I ---------------- Aiterations"an-d/or recommendations___________________ IM ---- ------ ----------------------------------- -•---•- ---- -... - -6 C7--------ap ------ R ---`-----------------------------------------------------------• --- I� I- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ,I ----------------------------------------------•- ----- k Mop �E FINAL 1NSPECTIO :- Date 1: ------------------------------- ------------- JOAQUIN LOCAL HEALTH DISTRICT I� 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stoekfon, California Lodi, California Manteca, California Tracy. California I E5-9-2M Revised 1-57 F.P,CO. I