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FOR OFFICE USE: - -- ---- -------- " """ " "". ""------- ----- -- ---- - -_ ---�~ APPLICATION FOR SANITATION PERMIT Permit No. �..._.... - - - -A.U� . (Complete in Duplicate)------------------ - #--- ---- Qate'Issued lQf-A'-__. 4K ---------------________________---------_----------- ___ This Permit Expires 1 Year From 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_complia c with County Ordinance No, 549. JOB ADDRESS A D OCATI Owner's Name------- -----------------------QE~= L'O `p - Phone -= - - - c w , 4_ ------- Address_........... t Contractor's Name---- -- -- -----C__)4_�K_- r----------------- ------------ -------------------------------------------------- Phone------------------------------------ Installation ---------------- -----------------Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court [3 Motel E] Other ❑ � Number of living units: ___1_._ Number of bedrooms _� , Number of baths ___ ._ Lot size ------/7- ` _��_____________________________ � rr` Water Supply: Public system El Community system [:] Private . Depth Water Table ........ ft. Character of soil to a depth of 3 feet: Sand [] Gravel [:] Sandy Loam [Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,dote------_-----.___..l No ❑ New Construction: Yes ❑ No..❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewerAs.available within 200 feet.) Septi ank: i Distance from nearest well_-_-�rE' _ Disfance from foundation._��P'__ . Material-____ ____f.___._____. '7' No. of compartments_____... ._____..___.__Size__ X_�_f Liquid depth------- .!__.---------Capacity__f4_q_ r_A Dispo I Field: # Distance from nearest well-- ----------Distance from foundation___-1-P_........Distance to nearest lot liners__.--____- Number of lines------____-'Y ----------------Length of each line_._.__..T-o................Width of trench--->__-___,__-____.__.___.__- Type of filter material_____ __ __________Depth of filter material-__1 Q -----Total length____/4P----------.__________.__.__J Seepage Pit: Distance to.nearest.well__._=-----=----------Distance from foundation--------------------Distance to nearest lot line___----____.-__ 1 ❑ } Number of pits----------------------Lining material_--------------------Size: Diameter.--.------------------Depth-------------- ------ Cesspool: Distance from nearest well---------------'_Distance from foundation----------__.'___..Lining material-------------------- ---------. L1 Size! Diamete�- M-- R Privy: Distance from nearest well... ..__________----..Depth -;----Liquid Capacity----------------------------gals, ► ------------------------__" kDistance from nearest building___..___..______.__.________________.-- _ � ❑ Distance to nearest lot'line; :-._�. _.___ : ----------------- Remodeiing and/or repairing (describe) ---------- �-". ^t ---•------------"--------------------------------•-------------------------------"---------------------- �!"j ► f ---------------------------------------------------- ------ -•-----�------------------------------------------------------' -- --------------------- ------------------------------------------------------------ N. I hereby certify that I have prepared this applicationland that the work will be done in accordance with San Joaquin Count ordinances, State la s nd rules and regulations of the San :loaquin Local Health District. , __ �} (Signed)------------ - - - ----- - ------ ------- ---- 1--------- -------------------------------------------- - �er and/or Contracto BY' - - )Titlel . ------------------------------------- ---- -------------- - --------- �(Plotplan;showing size'of-lot,-lo'cetion of syste inwrelation-to wells;buildings;_etc. can-beTplaced-on-.reverse side). , F,OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY, . !i!? ----------- ------------------------------------ DATEID---- ------------------------------------ REVIEWED :----------------- ._ . --REVIEWED BY-------------------------------------------- ------------- ---- - -- -- --------------------------------------------------- DATE--------------------------------------------------------- � BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---- --------•------------------ ---------- --------- _ Alterations and/or recommendations-------- -- ------ ------------- --------------------------------------------------------------•--------------•-----------------•------------ ---- --------� ---- ---------------------------------------------_-_------------- ------------ ---------------------------------------------------------------------------•----------------------------------------------------_ 1ju --------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- ----------------------------------- --- ------_---------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- -------------------------------------V. ------------------------------------------------------------------ ----------- - ---/--------------------- -------------------- FINAL INSPECTION BY:. f - � ---------------- Date-----./--- __� '_�.I-. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktanr California Lodir California Manteca,California Tracy,California F.R0 Q.