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�,�, t �',�__ APPLICATION FOR SANITATION PERMIT Permit No. __ d___ - s �� (Complete in Duplicate i� � ) � e ' ��.1� Date Issued __ 3 Application is hereby made to the San Joaquin Local Health District for a permit to construct j install th work i This application is made in;compliance with County Ordinanc No. 549. e rk herein described. JOB ADDRESS AND :E< ATION----- ------�� _ z. Owner shame = - ,_.. - ----- Address _ . ----- c.---- I --------- _____-.__ '� f Contractor's Name__ - - :phone Installation will serve: .Residences Apartment Ouse ❑ Commercial _ ❑ Trailer Court tMotel Other [❑ ! Number of living units: __ --_ Number of bedrooms .� � r � _,.Number of baths _ __ Lot size ___ ------________ Water Supply: Public system Community system -- Y Y �� Private ❑ Depth to"Water;7ableft. ' l` ! Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loo^am 0 •Clay Loam❑ Clay ❑ Adobe Hardpan ❑ k �Previous Application Made: Yes ❑ Nb New Construction: Yes NOE] t� FHA/VA: Ye ❑ No TYPE OF INSTALLATION AND SPECIFFIIC—ATIONS: [No septic tank-or•cesspool permitted if.public sewer is available within 200 feet.) # Sep pc Tank: Distance from nearest wel Distance�fromo dation__ l ----.M teriai-- 4 - r No. of compartments-., — e� _ .`�/` .. --- -- Size_. .A/ `Y'," ..2�i !d depth ------Capacity-------- Disposal Field: Distance from nearest wolf . i Distance from foundation .l�__-�_-._.Disi-ance to nearest lot line_____ _________ Number of lines------/----------- ! I' R �_Length of each fine___-- __- --------.W! th of french ------- { ,Type Of filter material_ r , ��` .- _..Depth of filter materia_ ': e 1 �... ..F. __._.., ...�_.. _.... ,.,� ........ Seepage.Pit: Distance to nearest well� _4 ------Distance f+p �� F .y o al Int f____ -, g h _ � Number of h5 0!1 : anon _ -. _ pista ce to nearest.'1ot fine_ ._ /-� �. Psts----2--------------Lining materia} Size: DiaRie er r ,; z, fro to t p, ------- Cesspool: Dis}ance fi om nea es ell______------------------i Distance from found ti ' r— T 1 . a - --------------Lining material------------------------------------- Diameter C1� ❑ - Size -- --- - D'" --------------------------"-- PY ` �' Lance from nearest well =DepthLiquid Capacity = gals. riv w !s I � �........��....�,.........�• ---------- ------------------ _ - . _Distance from nearest bviidin9 r. ❑ D!sfahce,to_nearest.Io.t.Ijne-,f_ Rem. �epainng (describe :- F _ - R __"----"-•-- •_________________'_______ ____________•___-"_________•_•__•____-__-.__________ ------------------------------- ----- __----_ "__-•-""---""""--"--" __________ _____________ ________ jj -------------------- - ______________•_________-____-__- T'�m.c-.��.�...v .�..-_.. .e. ! hereb certify hat I have prepared this application an --that the work will be done in accordance with San Joaquin County ordinances, State'laws and rules and egulations o the Sa doaqui:f.'ocal Health District. _ . signed)_ - { B " - t = �Iaced__on,r..Vers (Owner nd/or Contractor) // �� - -----------=- ----(TPlof Ian s' } �,rI P IL -----gt a of !o c i n system mells, buldings,.etc., can 6etrpode. ) _ FOR DEPARTMENT USE ONLY It APPLICATION ACCEPiTED.BY_ _�____ _; 3 ' DATE REVIEWED BY l= -l= ` I ---------------------- BUILDING PERMIT ISSUED t -------------------------------------------------------- ,_ DATE Alterations and/or recommendafions:___ .:__ _ 'DATE-__'_"'_"" _ :_-------------------------------------- / _ _______________ ___________________ ------------ (f ___________________________________�_--_____.___- 5 - ,:� .� - --------------------------------------•--------------------------- ------' --- ------------- -------------------------- Q { /r ____ _ __ ..; , ----- ---- - -- f FINAL INSPECTION- BY:_ : _ - "- ---_._--- �'". Dat ___-_-- -•_-- --------------------------- SAN JOAQUIN LO L HEALTH DISTRICT 130•South American Street 300 West Oak Street 132 Sycamore Street Stoc814 North 'C" Street kton, California Lodi, CelifornieManteca, California Tracy, California E$--9-2M Rovisea 1-57 EP.CO.