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FOR OFFICE USE: <br /> f" ----- --------------- Permit <br /> ------------------- -- ------ ----- - <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------- __ <br /> (Complefe•in Duplicate) Date Issued .5--= ��----- <br /> ` - This Permit Expires 1 Year From Date Issue <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work he <br /> described. <br /> This application is made in compliance.with County Ordinance No. 549. <br /> f <br /> ,. ------------------------------------------- <br /> JOB <br /> -----------------------JOB ADDRESS AND LOCATION. r <br /> Owner's Name <br /> ----------- ----- -- <br /> ----------- --------------------------.. Phon;------------------------------------ <br /> r,� - ------------ <br /> Address ::. ---------------------------------------------------- <br /> �f'' � /"__ ---------------------------------------------- Phone..__:_'�-r..-----•---•----•------- <br /> Contractor's Name---------•--yl�--fwra �`' ------------- ------ <br /> Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> .Installation will serve: Residence Apartment House ❑ ❑ ol <br /> ii ---- Lot size --� -�?'�.._�_,�,�------------------------- <br /> Number of living units: _!._-. Number of bedrooms _-- Number of baths _� <br /> ,p ft <br /> Water Supply: Public system �,Community system [❑ 'Private ❑ Depth to Water Table ` <br /> Character of soil to a depth of 3 feet- Sand ❑"y Gravel ❑_,1. Sandy Loam ❑ Clay Loam ❑ Clay ❑ <br /> Adobe ardpan ❑ <br /> Previous Application Made: (If yes,date_.._------------- 1 No'g' New Construction: Yes ❑ No. FHA/VA: Yes �o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: +�'. r. l <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) "` <br /> Septi Tank: ,i Distance from nearest well_.._..-----------Distance fromn foundation---_._._____.___--Materiai --------------------------------------- ------ <br /> No. of compartments---- -- ------- --Size-------•- Liquid depth - Capacity <br /> �V---- ` <br /> Disposal Field:-- Distance from nearest weli.___n---_._.-Distance from foundation��`'._. _ � Distance #o nearest lot line_a��-.----- m� <br /> 4_ en th of each line____- - Width of trench.,Z.___----___--------------- V\Number of lines.__.___------------- - 9w <br /> Tyd- ype of filter material-/. Q' epth of filter material_.. f ---Total length__._._ -----------------.------- <br /> Ir <br /> See a Pit' Distance to#nearest wsl!_.___""" --. ----Distance fr m fo ndation---Z-0-___---_ Distance to nearest lot lin`_ --------- <br /> A <br /> Number of pits--'--`------------Lining materi;IX. 4 . Size: Diameter-_ <br /> ------ Depths s ----------------- <br /> moi! _...___- "Distance from foundation_..._____._._.._ ..Lining material------------------------------------- <br /> Distance from nearest well ----- . <br /> CesSlodf` +R <br /> ❑ Size: Diameter. ! --- ------- --------- ---Depth- --- -- --- - --- ------------ --------------------Liquid Capacity....------------ ---------gals. <br /> PrivyDistance from nearest well_____---------__'_..___.- <br /> ------------ ------- <br /> ---Distance from nearest building-----:------------------------------ ' ' ' <br /> ❑ <br /> Distance to nearest lot line n__ _---V ---------------------------------- ----------------------- <br /> t <br />' <br /> - <br /> ' <br /> S! '----------------------- ------ = <br /> Remode4ing and/or re airi�(.escntbe)�.!_- = r <br /> ---------------- <br /> Lt�� _ _ _ _ <br /> I ertlf y ha that I have prepared�;epared this application and that the work will be done in accordance with San Joaquin County <br /> I ereb c <br /> i ordinances, State laws, and rules and regulations of the Sang Joaquin Local Health District. <br /> --- ------- --------------- ------ Contract <br /> ��r46---L�t��-V. r or) <br /> (Signed) . .._ ! tl ]---(TI e--. _- -- -- ----- ----- <br /> BY:--------------- . t - ' _(Plot plan, showing size of'lot, location of syre n to wells, buildings, etc., can be placed on reverse side). , <br /> VFO: DEPARTMENT USE ONLY <br /> ,F1 VAPPLICATION ACCEPTED BY - ----- DATE------ r <br /> K, <br /> RDATE------ ----------------------------------------------------- <br /> REVIEWEDBY.---- '-------------------- -------- - -.._---- ----------------------------------- -------------------------- ---------- ,, <br /> BUILDING PERMIT ISSUED --- ----- ; ------------------------ <br /> AlterationsDATE <br /> and/or recommen ations:..................._-"_..--.-.------------ -------------------------- ----------------- <br /> T -----------------'--------------------- <br /> I , <br /> -------------- ---------------------- -- <br /> r <br /> ------------i----------------------------------------- ---- <br /> ------ ........---------------_.___...- ............ <br /> ' i I <br /> Date----- <br /> I <br /> FINAL INSPECTION BY:-------- -------...---------------------- -------- <br /> ------- --- ----- -------- - --- ---- ------------- ------ -----i - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r ». <br /> 1b01 E.ffaxelfon Ave. Lv 300 West Oak Street +'♦ �`�l24 Sycamore Street, `t 205 West 9th Street <br /> Lodi,California Manteca,California Tracy,California <br /> Stockton;California. R <br /> E.H.9 2M 1-67 Vanguard Press � ` <br />