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FOR OFFICE USE: tA9' t,-------- -------- --- l--- ----�:�-�t� - � - �-E___7_J-------- APPLICATION FOR SANITATION PERMIT Permit No. ................ .. � ----------------------------- ----------------- . . �.. A_ ..(Complete in,Duplicate).� _ . . �. ,. This Per' ' ` Date'Issued _____-- -•L ,�rc' _ mit Icxgires 1`Year From Date Issued i r Application is hereby made to the San Joaquin-Local He-alth.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 AEN LOCATION_ . __ F �' J " " ------ -----------------------•• --------------_. . Z - . Owner's Name. - - - --------- - --=-- ------•-•------- i -- - - ---- Phone------------------------------------ Contractor's Name=------- • •- Installation will serve: %Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other` ❑ Number of Diving units: Number of bedrooms Number of bathsLot size ` _- . . ._ 1 . .rte �,� � Water Supply: Public:systemCommunity system ❑ Private .❑ Depth to Water Table 4. , � t Character of soil to a depth of 3 feet: ;Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe :' Hardpan ❑ Previous Application Made: I(If yes,date___________________) No,� New, Construction: Yes ❑ No ��HA/VA;Yes ❑ No TYPE OF INSTALLATION AND SPEC IF_iCATIONS - No septic tank or cess ool�ermined if public sewer is available thin•20Q feet. t I P � P P P ]`-F 1 , SeptS TahkDistance fromneare��well----------------_Distance from foundation_ :fit!----Matt; ial____ ---------------------------------------- No. of compartments------"""*'-,-----------I size--------------- ------Liquid del? h_'\_----Ii-------------Capacity -------------; -------- Dis�Oal le�p Distance from nearest well_ _ -=Distance from foundation--------------------Distance to nearest lot line_-_----_------. Number of lines-------------------- Length of eacli line_________________ '------.Width of french--------- ------------------:-..._-- Type of filter material-t--•--------------------Depth of filter ----_---------_ - material '_- ----Total,(length----_--•-----.-- _.--------- ------ f t'y t r / 1- Seepage it: Distance to nearest well._.__`'__#Distance f m fo dation___- r ____ Distance to nearest lot line__ Number of pits___-�--.#_---_--.Lining material, _Size Mameter._. ��__.-Depth__ i f I I Cesspool: Distance fi•am�nearest,well_______________�Distance from foundation._--_.._-___;.___._.Lining material---------------I___.___._____________ ❑ Size: Diameter.__--------- ------------------- --Depth--------------------------------------------------------------- ------Liquid Capacity------------- -------gals. Priv Distance frorh r"a-rest1well------------------- Y' i . . � } ------------------------------Distance from nearest Ouiidin9------`�---------�-------,;--,--------- ❑ Distance to nearest lot line-----.------ -------------------------------------------------- l--------------�- :---- e Remodeling and/or repairing (c1!ibe):-- ........ gip= ---------- -------------------------------------- 4 4 . ' 4 11 e ------- Fhereby certify that I have prepared this application and that the work will be done'in accordance with',San Joaquin County ordinances, State la s, a rules-and 'gulati ns of the San Joaquin Local Health District, o bx ti ► (Signed) •---- - -- -- - -------`r ` �' ( Contractor] BY: = - , ---{Tale}- �f } l (Plot plan, showing.size of Ibt, location of system.i la ion,fo wells,;buildings, .e'fc�.an be�,placed on reverse side). FOR DEPARTMENT USE ONLY } /V REVIEWED BY '�-rwy _` l DATE ------------------ ---- . ----- r.._,..,.,, - 7 r APPLICATION ACCEPTED BY-..-.7 r� ---------------------------------- DATE---- � = k - ------------------- __ ... _ ______._____.._____________-_-_____--_-- __-----_--_---____?----------------------------------- ------------- BUILDING PERMIT ISSUED.------------------------------' ri -- ,f DATE.... } r c t _ --�• L r Alterations and/or recommendations:.--_ -cam-- _ { ---C-----------------------------------�� _�'-I -- 63 f --- < '. r .f� i - ---------- ---- `� - ----------------------------------- -r - 11 --��---- f i ------------------------------------ f --------------------------- __-- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------`-_-___-__.-----__.--___--.-__--_---_-__-..-____-__.-_-- p.._-_----.-___-------_.-.__------_-__--_---.----------------------------------------------------------------------------- FINAL INSPECTION BY:--- ......... --- ------------ Date--- t Zit - � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E..Noxellon AvQ, b 30 \� 0 West Oak Street\. 124 Sycamore`.Streef 205 West 9th Street slocklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CO.