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FOR OFFICE USE: :i � -------- -- --------------------- ------------- _..___ ---------- .. ..........._.._-..____---_.__.. APPLICATION FOR-SANITATION PERMIT Permit No. -------- ----------------------- ------- (Complefe•in Duplicate) - - --- This Permit Expires 1 Year From Date Issued 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 complian a with Co u ty Ordinance No. 549. E VAI- JOB ADDRESS ANDLOC �.1_D7 SIN f�{ (� '� �j�_____-I U1 ----- ZZ(p - fJ`fb 23.-- Owner's Name-------------------•- M.. L ��'-------------- Phone_ - --"',------------- Address y ' Address-------- ,— c• -- ---------•----------------------------- ---•- ---------------- Contractor's Name---- f�-_t 1_.._ C'®l�/ T:-----57 , $ ` - � I 4ff Installation will serve: Residence eApartment House ❑ Commercial 0 Trailer Court ❑ Motel E] Other ❑ Number of livingunits: --I.--.- Number of bedrooms -_ � I 1 ._ Number of baths __ Lot size ---1.?�- ------ i�---.----------------------- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table Y_ - ft Character of soil to a depth of 3 feet- Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan F N Previous Application Made: (If yes,date---------------_- I No New Construction: Yes �o ❑ FHA/VA: Yes 2---No ❑ TYPE-OF_INSTALLATION-AND SPECIFICATIONS:_ _ -_ _ _ _ _ W i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N__ 1 Septic .ank: Distance from nearest well----- Distance from foun tion.._l�Q__- --_- Material .-576/uCg.F No. of compartments__..__. ;.------- Size._*1_ _e__ .___Liquid depth.- _z I Disposal Field: Distance from nearest wel!__ --Distance from foundation........../0._ris-t'n'ce to nearest lot line _ Number of lines_____ -1 ----_____Length of each line__? ___d-_75of trench........ . Type of filter materiaf_-Pocr-1------Depth of filter material------_1 -------Total length.________-j C ._____•-_------_. S Seepage Pit: Distance to nearest well______________________Distance from In; Seepage to nearest lot line-----...-.__-__- Q"' ❑ Number of pits--- ------------------Lining material----- _------------- Size: Diameter----------------------- Depth----__-__-.-___.----_.-- ------ Cesspool: Distance from nearest well ----------------Distance from foundation-----_-----------_.Lining material--.-.--,--------------- ------------- ❑ Size: Diameter- -- -------- ----- ---------------Depth-------------_----- -------------------------.-.-Liquid Capacity--------------------- --gals. Privy: Distance from nearest well------ __-----.-_.___._.....................Distance from nearest building_-------_--------------------- ----- Cl Distance to nearest lot line --------------------------------- Remodeling -------------------------------Remodeling and/or repairing (describe)--------------------- ---- --------------------------I------------------------------------------ --••------------- ------------------------------------------------------- -------- ----------- -- -- ---------------------- -- -----------------------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 laws, and rules and regulations of the San Joaquin Local Health District. E (Signed)----- r ----------------- --- - ---------------- --------- (Owner and/or Contractor)- �. , _:: -------- ----- ---- ------------ �Y `-'----- ---------------------------------------------- -------- -------------------- - ------(Title)---------- -- (Plot plan, showin size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 'FOR DEP MENT USE ONLY APPLICATION ACCEPTED $Y-_-_:._ -C� ........... .. - DATE-...------- -----' f £ .n REVIEWEDBY------------------- ------------------------- --- -- ------------------------- ------ ------------------- ----------------- DATE -BUILDING ---------------- PERMIT ISSUED-------- -- ------ ------------------------------------------- Alterations -----------------------------------------Alterations and/or recommendations:-- -------- - ---------------------- - - - -- --- 15�_ --- 3- -7--------ter- C A 1 - - -------------------- ------------------- -------- ------- --- --- ----------- ----------- -.----------------------------- - --------- ----------------------------------------- .. ------- . ---------------- -- - ------ --- ------------ --- ----------------- - ` FINAL INSPECTION B // 11 .�. - -- - --- - Date = -S�7 --------- ------------------------------ SAN JOAQUIN LOCAL,HEALTH DISTRICT 1601 E.Hazelton Ave. 300 Wes?Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi, California's= r Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press