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�. ... , +FOR OFFICE USE: �^ ----------------------------- Permit Nl Cc l J s 4 r _ ---�----. APPLICATION FOR SANITATION PERMIT o. - F ------------------- (Complete in Duplicate) Date Issued =_ -�-=-Cr - ----------- - ___.__ Thi' Permit Expires.1 Year From Date Issued _. -4-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 County Ordinance Nd. 5. c _ r✓ y�, 0 c�,1214-� ------------------•---------•----•----------•----• ---------- ----- ----•----- JOB ADDRESS AND LOCATION-_ p0_/_ -___._-__-- !�72e.,�- -------------- '". - Phone Owners Name------- at, P._° - , Address ca -------�/�f -e..--- --------------------------------- Y Contractor's Name-=. --- --- -- -- -------- - -- one----------------------------------- Ph Installation will serve: r Residence Apartment House El -Commercial ❑ Trailer Court ❑ Motel ❑ Other El � � -, 1 G•a------ Number of living units: _..._ Number of bedrooms .,„- Number of bather--- Lot size ._ _ _ _ Water Supply: Public system ❑ Community system Private ❑.. Depth to Water Table.�k!rff. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sand Loam [I Clay Loam ❑ Clay ❑ Adobe EI-14-ardpan ❑ Previous Application Made: (If yes,date.-F- - --- New Construction: Yes jR-<o ❑ FHA/VA: Yes [Y�o El TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted•if public sewer is available within 200 feet.) Septic Ta Distance from+nearest well-___--.i Distance from foundation- -d_�__ Matf rial" �':�_C-- --------------- ---• No. of compartments---„�----------------Size__ -x-l��- ---Liquid depth--- _-------------- ---:Capacity_..Z_ _ --- Ik t Disposal 'eld: Distance from nearest well_.�'�'..____.Distance from foundation__.)�..�_____-Distance to nearest lot line___r5r______.. Number of lines---------��------------------Length of each line___.-'74-- ---------.Width of trench -f------------------ 4Type,of.filter.material_s,r�P._7.�C k-Depth of„filter material _��------Tota4 length_____ fit-= --------------------- Type. ------------------- Se it \\ Distance to nearest well-_--_.ter------_Distance from foundation__,/a/------.Distance to nearest lot line.-.S- ---- ,�r J Number of pits----- ---------Lining material--- -_Size: Diameter---7&-i1------ -.Depth----/—! -- --- Cesspool:111 Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------______--” i ❑ Siz,e: Diameter-------------------- --------------- Depth-------------------------------------------- -------Liquid Capacity------------------------- Privy-. Distance from nearest well____________________ ___________ ------Distance from nearest.building--------------------------------.---------- [j I ❑ Distance to nearest lot line-------•------- -------------------------------------------------- ------------------- ------------------------------------------ 1 Remodeling and/or repairing (describe):--------- ----��-:--- "T----=------ -- -•---------------------------------------------- ------ r - _____________________________________________________________________ --------------------------_--_____-____________._..--_-_____ r ___________________________________.-----___--________-_______._____---_-__.._----.___"-------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules&14N,egulations of the San Joaquin Local Health District. ' n Co act (Signed)_ - -- ---- - -----'Ct5m �, � --------------- -------------------------------------------------- --------{Owner and/or ntra or) = { ) By:--------------------------------- - Tete - -(Plot plan, showing size of lot, oc iosysten relatio wells, buildings, etc., can be,placed on reverse side). FO PA T ENT USE ONLY /f APPLICATION ACCEPTED BY s :... - = DATE------ _� - -G° ---------- ------ REVIEWED BY - : -------------- DATE------------------------ BUILDING PERMIT ISSUED----_----------------- ----= ------ DATE-------- ------•-------------------------------------------- Alterations and/or recommendations------------------------ -------------•--------- ---------------------------------•------------_ --------_------- • ------------------------------------------ ----- -------------•----------------I- ------------------- ----- ------- -------------- ------------ ------ ------------------------------------. Ir i FINAL INSPECTION BY--------- -- --- --- = Date-----�J� ...: �-------- SAN JOAQUIN LOCAL HEALTH D157RICT 1601 A.Ha:ellon Ara. 300 West Oak Street 124 Sycamore Street 205 West 911h Street SfoEklon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6.59 3M 3••63 f.P.CO”