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fVk ul-W-k USE: ------------------ ------------------------------------ - -------------------- -- -------------------------------------------_--_------- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. a, --------------------------------- - ------ {Complete in Duplicate -------.--. This Permit Expires 1 Year From Date issued Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made ingm�lia ce with County Ordinance No. 549, JOB ADDRESS AND CATION_:__------ - - __/ Owner's Name-- .,.-...- - --- ----- - - ------•-- - '--------- - ----•---------- ----- �- -- Phone-----"•-•- Address 1` #---f�---F--------------------- - - -=----- ..-•----- Contractor's Name --- •-•--- Phone-------------------------- Installation will serve: Residence Apartment House '❑, Commercial E] Trailer Court E] Motel El Other E] Number of living units: J Number of bedrooms;o-k.- Number of baths .---_.._ Lot size ---- ��.,.(��_________ ______ . t :- Water Supply: Public system El Community system E] Private�Depth to Water Tabl Sj1 ft. Character of soil to a depth of 3 feet: Sand ❑ Graver Sandy Loam 4 Clay Loam ❑ Clay ❑ Adobe [] Hardpan �❑ Previous Application Made: (If yes date--------------------) No New Construc 'on: Yes No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 0-11212 •'fes J ` -��t�r '�tJj � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) [VJ Septic Tank: Distance from nearest weiI_-_ ,_9 ))Dist ce fro mon---- --- Mater I d Y__-___.__- No. of compartments Y p Size ,>__LiquiiJ depth-------- -----------Capacity--/A•�� c � Disposal Field: Distance ofolines nearest well-,D--Distance from foundation -�5-�-_-._. ista�. a nearest lot I'ne_ �� Q f , w f ��--------- -Length of each line.9 4 -. id hof renchh.�-, - ----------------- /��_ h Type of fitter material-5-.3 L_ Depth of filter ma terial___..__/_ .---Total length.---� _-_-=- c-c�` x 57epage Pi�: Distance to nearest well_vZh0------Distance from foun atkioq-_: - _-._--.Distance to nearest lot line /07l / � Number of pits.- __.�.-.- Lining material - �fi __ ^ �1 /' -,a �� Depth--- - ~-lC --/�� f� spool: Distance from nearest well-----------------Distanceirom f undation_---------.---_--...Lining material_- ---------------------------------aoW ❑ Size: Diameter--- F t Depth. --. --- -----Y ----`---- -Liquid Capacity ------- -----gals. Privy: Distance from nearest walla --__..-----. . -- -- ---- ------Distance from nearest building------------------- . ----------- - ❑ Distance to nearest lot line------------- 1 r Rem Jelin n4/or reairing (describe]: - --lJ-7].___ -- -----' r4ti`L (sem I hereby ertify that I have prepared this applicationhe work will be done in ac ce wit1�an khat tn Joa uin County ordinances, Stat , and rules an reg latiores of the San oaquin'Local Health District �'� (Signed)_--- ( wner and/or Contractor) ------1�-------- •-- - - ----•�-'- - - O By: --------------------------------------------------------------------------------------------- Title)-------- -------------------- - ------------- ----------- P (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). � I ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------ - ----- ------------------------- ------ DATE------ ---- ----- --- ------------- REVIEWED BY. - � D TE �/ � --- ' BUILDING PERMIT ISSUED-------- ------------------------- --- ------------------- ------------------------ -----t�- ---- -TE- ------ TE ' --------------------------- Alteratio n;and/or recommendations:--------------------- ---------------------------J--------- -------------------•-----------------------------•---•--------- 11 . --------------- r :�/ .i/C1!% !S/Y ar- ----------- -- ----- ------------------ [ r ---•-----------+ f-�'4-A_, l�r1G ` �C__ r 1 i ------ ---- ------------------- ----- - ----------- ------.- FINAL INSPECTION BY--------- -- ---� Date -.r 2 �. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 5tocklon,California Lodi,California Manteca,California Tracy, California