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FOR OFFICE USE: -------- ---------------- -------------------- - --------- ------ - ------- Permit No. .- ! �. � -------- _-. ---�I---- APPLICATION FOR SANITATION PERMIT I1 (Complete-in Duplicate) =-- - ----� ------ Date Issued r ---------- -----__----IM'-._ This Permit Expires 1 Year From Date Issued Application is hereby madel�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. ✓ 4� �,/�------------_--------------------------- > JOB ADDRESS AND LOC ATION_..________ ____ ._. . -_.-____------ Owner's Name---- 7 _ Y --- -- Phone-------------- -------------- Address----------'� {-0- Ill�-r ....... --------------- ------------- t-------------------------- •----------------- ..------------...- ql _ _� v Ao Contractor's Name-------------- _ ------- ---- Phone °Ih. i Installation will serve: Residence 1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ul Number of living units: _. Number of bedroorns .-.?. Number of baths _/__ Lot size _J _______ _ ___ ____--------__________-----._ i Water Supply: Public syst L ❑ Community system ❑ Private Depth to Water Table 74--f t l Character of soil to a dep+11 of 3 feet- Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay [3 Adobe Hardpan ❑ Previous Application Made: (If yes date_..__-_-_.:..--. 1 No ❑ New Construction; Yes ❑ NoX FHA/VAS Yes ❑ No ❑ TYPE OF INSTALLATION..AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) III ti k: Distance from nearest well.............:...Distance from foundation------------------- Material ____......-..-.__-._....-._------_---_---_._.... No. of compartments ----- --------=--�..-Size------------------- -------Liquid depth------. - -------.Capacity...--- -----------•----" .Ij I ryrye�,,_ Disposal i Id: Distance from nearest well..-O_.._._Distance-from foundation____/Q-._.Distance to nearest lot line_,s Ji. .� Numberl of lines.......... .......... Length of each line__ --.•rte._---_�---.Width of french----_-yr� _- Type of`filter materiaL_.Jr feQ�-Depth of filter material.___ - Total length_-_- ___________________________._ .II � r Seepage t: Distance to nearest well_Z6V_._f_--Distance f fo dation___4!.-_____Distance to nearest lot liner---____ 6 Number of pits_. __, ----..-------Lining riiaferial_ Size: Diameter_�.7._.-----_-Depth__...P Cesspool: Distance from nearest well "_--"'-,_:._...Distance from foundation.-_- ------- ..Lining material____________________________________ Size: D - iameter- ------------ ----------_• --_.Depth--------------- ------------ - -- ------ --------Liquid Capacity---------------------- -----gals. Privy: Distance Distance from nearest well___...............__.-.--_.-.---.__.-..-.-----Distance from nearest building.--.__...-------...____._____----.-_-.._. ❑ Distance to nearest lot line------------- - - - - -------------------------- ------------------------------------------------------------------------------------------ i Remodeling and/or repairi'rig (describe): ----------- - --------------------------•--------------------------------------------------------------------------------------------------- -------------- •-• ---------------------I �- �--------------------------- ---- --------_°---°_--_------ ----------------------------------------- ------------------------------- --------------------- --------------__- I I'------------------------------------ - - ----------------------------------------------- I I hereby certify that . have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules nd gulations of the S Joaquip Local Health District. Si ned h --- --- ----- - - - -- --. ------------------------- -eaceddon wner and or Contractor) -- r By:------------•--- --------- I�I ..................(Title ---------- (Plot plan, showing size of lot, location of system in relation t buildings, etc., can be erse side). FOR DEPARTMENT USE ONLY vi ---------------------------- -------------------------- DATE. APPLICATION ACCEPTED BY. ------ -- -------- -- ----- ---------�.---------------------------- REVIEWEDBY---- - ----------- � DATE------------------------------------------------------------ BUILDING PERMIT ISSUED -- D _ Alterations and/or recommendations:.------ ---------- 0 i --------------------- ---- -------- - ---•--------------------------------------- I ----------- --•----------- - --- ------------------------------•-------------------------- - -------------- ------ -------- ----------------------------- -------------------- --------------- -- ------------------------ ----._. ------------------- -------------------------=-------- ------------------------------------- ------------------ - -- � - -----------------•-•------- �1---- ------------- --- - -------- ------------- --------- --- } ---------...- ------------------- - ------------------- -- ------------- -------- -- ------- ---------- - - FINAL INSPECTION BYN:-.v. .:------ ---------- Date --------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=ellon Avg. 300 West Oak Street 124 Sycamore Street 245 West 9th Street stocklon,`Californial Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 vanguard Press s ��