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FOR OFFICE USE: --------------------- -------- ------ --------- -------------------- -_--.. APPLICATION FOR SANITATION PERMIT Permit No. .431'41,5_ f� 3-.T 3- ""_`""�� -- (Complete in Duplicate) ---------------------------- ------ ------- This Permit Expires 7 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 compliance with County Or in nce No. 549. JOB ADDRESS Ira CATION__ " " --• l / ------ Owner's Name______ -- -- -•-- -- Mfr Addresone- s-----------•-------- -Vaz/. - - ----- Contractor's Na a --- -----------•--------------------------------------------------- - ---------------------- •--------- ---/. -4- -- A� ----- t----- --- ...... Phone Installation will serve: Residence Apar enf House ❑ Commercial � Trail r C c�+_ IV- Number �[� Motel ❑ Other of living units: _______ Number of bedrooms ________ Num er-of baths -------- Lot size ---- --- ,,- ------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe rdpan Previous Application Made: (If yes,date___-- ----------) No ❑ New Construction: Yes to ❑ FHA/VA: Yes [_1No v TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _µ --Distance from foun fiiop --__ .__.Material________________ No. of com artments_- _ -- �� r - --------"------ ! P ----------- ---Size - �Ciquid depth. -----o��-r,------Ca acit Oi0 Disposal Field: Distance from nearest well" J__Distance from foundatio rko Number of lines.__ ---."Distance to nearest lot line_--.___" I --- ------,_-_-- -- _, Length of dash line---- __ ® � Clr/ Width of trench.. Type,or,{ilter,material� --Depth,of filter material____ - Totaf length_ __ � j �Q 7 Seepage Pit: Distance to nearest well_1 ".___--___--"___Distan from foundation_ �._ _�_ P 1-----------------Lining material_ ____a�_ —Size: Diameter. -Dis -- a nearest lot �e___�� l fi Number of its-_. � � �� i _.Deptn--- -------------- Cesspool: Distance from nearest well _ Distance from foundation._____-"-_.__--- .Lining material-_..._________.__""--_ ❑ Size: Diameter ------_.Depth------------------'- ------- ---------------------Liquid Capacity---------------------- gals. Privy: Distance from nearest well--------- --.----"____a------------- Distance from❑ nearest buildin _ g----------------------------------------- Distance to nearest lot line_..._..__. , , ------------------------------------------- Remodeling and/or repairing (describe):____- # -----------------"----------- ----- -- �------------- ----- -------=----------- - ------------------------------------ k -------------------------------------------------------------------- ------- -------------------------- ----------------------------------------------------•----------- ---------------------------•---------------------------- ------- # I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, in ules and regulations of the San Joaquin Local Health District, ' 2`�`� & �i�4t (Signed) SERVI"� -------------- ------------ ---------- - -------------------------------------- Ave, Contractor) ---By:__-2915 E.Miner - .Ho.6-3841 Title ---- r (Plot plan, showing size of lot, location of system in relation to well buildin s etc, can be placed on reverse side). ----__...__ .......... .--- . --------------- 9 . FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY_--- _ 4 - - -� DATE ' -5 REVIEWED BY------------------------------- ---------- ----------------------- BUILDING PERMIT ISSUED-------•---- - DATE --- ------------- --------------- -- �--- ----- DANE---- �----------- - Alterations and/or recommendations:_______ --- -------------------------------------------------------------------- FINAL INSPECTION BY:. �k�P :_ .'.,_ Date -P------(.'. ��_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street 1 Slockfon,California Lodi,California Manteca,California Tracy,California i I