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FOR OFFICE USE: <br /> a APPLICATION FOR SANITATION PERMIT Permit No. <br /> --- -------------- --- - ------------------------ <br /> ----------------------- <br /> --------- ------------- <br /> ---=------------------ - --------------- --------- (Complete-in Duplicate) <br /> - . . bate Issued <br /> --- ----------- --- -- --- -------­-----------------'� _ _This PermitHealth D} Issued <br /> d 1. - _Expires tl Year From ate ss <br /> Application is herebp•made to the San Joaquin Local Dist for a permit to construct and-in"—all the work herein described. <br /> This application is made In compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATI t� � / � I - <br /> Owner's Name-------. ------ --1191- ---••------------------ ----------------------------- --------- <br /> r - <br /> Phone---------•-•---------_---- <br /> Address-------1.1L�G'A ------ --- f- ---- --------� _. <br /> Contractor's Name =__ �r- Phone._..----------------------------- <br /> Installation will serve: Residence [R-Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel [j Other ❑ <br /> Number of living units: _/__ Number of bedrooms ?__ Number of baths .. -- Lot size,r2 _,��fie�_0_______________________________ <br /> Water Supply: Public system E] Community system [I Private [Depth to Water Table AG _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Applicaf6n Made: (If yes,date_-...---------- ) No Z�,' New Construction: Yes R��o ❑ FHA/VA: Yes [—No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> E (NO septic tank or cesspool permitted if public sewer is available within 240 feet.) <br /> r � <br /> Septic Tank- Distance from nearest well-�d____ _Disfatnce from��fjooundation__._ --------Materia ----------------- <br /> No. of com artm __ <br /> ents_ 2_________ _______Size_ x _-___ - Li q u i d de th."i� Capacity/ 49..... <br /> Disposal Field: Distance from nearest well- a-----_Distance from foundation__��-�_._.Distance to nearest lot line_ ._�_.. <br /> Number of lines ------ ------__ -Lengfh of each line__�,Q-`-----------------Width of trench, ---------------------- <br /> i _Depth of filter material- _-___..__.Total length .. -.-________________._ <br /> Type of filter materia/f.,4_ <br /> Seepage Pit: Distance to nearest well......................Distance from foundation------------------- Distance to nearest lot line______________._ y <br /> ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter-----------------------Depth............--------------------. <br /> Cesspool: Distance from nearest well ________________Distance from foundation..- ------------- ..Lining maferial__-_...____....___._ <br /> ❑ Size: Diameter- -- ----- -- ----- --- ------------Depth------ --- ----------- --------_----------------- Liquid Capacity- - -----------------------gals. <br /> Privy- Distance from nearest well,-,-M--__�_------------------------------ --Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line------- ------------ ----- -- ---------------------------------------------------------------------- ------------------------------------ <br /> i r <br /> Remodeling and/or repairing (describe):__-_-- <br /> ----_----------------------------------------------------------------------------- ---------- <br /> _.--. ------- <br /> -----,-------------_--------------------------------------------------------__._----_---_-________-.________._._____________________-____________.__-_-----____----___..----__-____.__.----_...___.______---.-- <br /> I hereby certify that I'have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, <br /> r (Signed)--------------------------- O - 'f l � - - ----------{�or Contractor <br /> BY:-------------------------------- ----------------------------- -----------------------{Title) [ y ._._..._...-------- <br /> (Plot plan, showing size of lot, location of s m in relation to wells, buildings; etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.------ ------- -- ---------------------------------------- DATE--- -3 _ ---1 <br /> - - <br /> REVIEWEDBY-------------------------------- --- --- --------------------------------- --------------------------------------------------- DATE-------- --------- ------ --------------------------------- <br /> BUILDING PERMIT ISSUED - -- - --------- -------------- -- -------- DA•TE----�=---------------------- <br /> Alterations and/or recomme , ations:._.. - _ ?__ <br /> ��.. :.. . --F------Gfi�� --y.�-. ---------------------- --- - <br /> . a <br /> �Zr %,c-,---- ------------ --- <br /> --- ----- �f----- - -- -e---------------------------------- <br /> ------------- ------- - '' ------------ ------- - ------------------------- ---------- ------------- - - -------------------------- <br /> ----------------- Date- -.-----------1:711111r7 ------------- <br /> FINIAL INSPECTION BY:--------- ___'.2 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haiellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stacklon,California Lodi, California Manteca,California Tracy, California <br /> E.H.9 2M 1-67 Vanguard Press ' <br />