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FOR OFFICE USE: -------------------------------- --------------------- .._.._...............�.\.., ..� __----_-------.---- APPLICATION FOR SANITATION PERMIT Permit No. �. ..��... - -------------------- ------------------------- (Complete in Duplicate) ------------------------------------------------------ This Permit Expires 1 Year From Date Issued 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 CountyOr ' ante No. 549. JOB ADDRESS LOCATION___ _ .. _ .�.. _ �t,,l_/._,3.�_,,� �`!._ ___ _ l � � Owner's Name----- -- -- C.�4'.�t...�.,/�---•-----•----<_�I{-�-t7--�-•------------•--------•--...---- t / - hone--- ...=- . ...Address--13.2.--�t----• - A -j - Phone. _�== / Contractor's Name,U41_ .. i . --- ... --_0•�p..�. f/ --- Installat'ton will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ , Motel ❑ Other ❑ Number of living units: _�.... Number of bedrooms_-- Number of baths Zteot size .Q_ __)K_14_6. --------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table A.7-ft. Character of soil to a depth of 3 feet: Sand❑ Gravel 171 Sandy Loam Clay Loam [:] Clay ❑ Adobe[:] Hardpan ❑ Previous Application Made: (If yes,date_________-.------._) N ° New Construction: Yesto ❑ FHA/VA: Yes Wj--`1No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest wel --------Distance from foundat• n---I - i --------------------- No. of compartments_.______.____'___Size. ..2({'. Liquid depth --- _____Capacity.. / Disposal Field: Distance from neAj&f well __ _._Distance from foundation.1.0!._.... .Distance to nearest lot line.......16•0 Number of lines__ . Length of each line/Q.v!._-_...Width of trench_ - -- ----------------- ---- ---------- ----- ------- Type of filter ateriahlLl�s1.+% _Depth of filter material_-_ __. Total length..../ Seepage Pit: Distance to nearest well____________________•Distance from foundation....................Distance to nearest lot line................. / ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well--------------- from foundation--------------------Lining material------------------------------------- 11 Size: Diameter-----------------------------------::.Depth---------------------------------------------- -----Liquid Capacity------------------------_--gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ID ___-__--__-_-.-.---___-__--..._.--_-.-.❑ Distance to nearest lot line --------- ---- - - --- --------•-....--•-----•----------------------- --------•---------•---•-• --------------- - A Remodelingand/or repairing (describe):----------------------------------------------•-------•-------------•--•-----------------------------------------------•----------------•--------------- ---------------•----------------.-----------------•---------.------------.-----------.----------------------------------.---------------------.----------.----------------------•--.--•-------.----.----------------------- ------------------------••----•--- ------•--------------•-----•----------------•------------------------------•--------------•-----------------•------------------•------------•----------.................................. -----------------------------•--------------------------•-••-----------•-----------------------------------------•---•-----------------------------•------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances S to laws, and rules and regulations of the S Joaquin Local Health District. m a n <? --- ----------------------------------------( r Contractor (Signed)--------- --- '#'�4W� ) BY ......-----•----•--------- ------ ------(Title)------------- - (Plot plan, showing size of lot, location of system in relation to IIs, buildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,.._ � ----------------------------------------------- DATE_-___._=� _fU --- ------------------------ --- -------------------------- REVIEWEDBY----------------- ----------------------- ------------ ---------------------------------------------------------------------- DATE-_----------------------- ............................. BUILDING PERMIT ISSUED------------------ -------------------------------------------------------------------------------:..-.DATE------- Alterations and/or recommendations---------------------------- -- -- ----- -------•-•-•------------------•--------......_�"''_'.....> . ------------=---------------------- --3'- :'. ---------------------------------- --- --------- ------ --------------- ------ - ---- FINAL INS ' P � -- Date----- ----------7 — ------------------------------ SAN ----- - ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1101 f.Nuthen AV41L 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stesknen,CoWernia Lodi,California Manteca,California Tracy,California CS 9 R9V481ra!-ft 3M-3-'63 F.P.CG.