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FOR OFFICE USE: <br /> Uya ------------- <br /> -------------- <br /> - <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------------------ (Complete in Duplicate) <br /> ---------------------- <br /> tthis Permit Expires I Year From Date Issued Date Issued <br />-- ------------------------------------- -- <br /> Application is hereby made to the Sa n.Joaquin Local Health District for a permit to construct and 'install the work herein described. <br /> This application is made in compliance/M6 Cou6ty Ordinance No, 549. <br /> JOB ADDRESS AND LOCATION------ 3 7 _X/o.o.e. ------------------------------------•------------------ <br /> Owner's <br /> ---------------------------------_------------------Owner's Name--------- ZIad- --------- e ----------- Phone----------_---------------------- <br /> ------------------------- <br /> Address--------------------------------------I --------- ------------------------------------------------------------------------------------ <br /> Contractor's Name---------A -------- ------------------------------------------------------------------------------...... Phone--------_____ --------------- <br /> � t I <br /> Installation will serve: Resid86ce [Apartment House El Commercial [] Trailer Court [-] Motel E] Other ❑ <br /> Number of living units! __L Number of bedrooms --Z.- Number of,baths __7_ Lot size ----- j--v------------------------ <br /> Z_ <br /> *- <br /> Wafer Supply: Public system &;.-4-:�'orrim unity system E] Private [-] Depth to Wafdr Table t. <br /> .. 1f5o <br /> Character of soil to a depth of 3 feet- San10 Gravel D Sandy Loam 0 Clay Loam El ti Clay.E] Adobe f}.-Hardpan 0 --4 <br /> date.... ...........N----j ew Construction: Yes E] No g;.�.�A/VAI Yes E] No-Zj__ <br /> Previous Application Made: (If yes L�0_ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ' <br /> sewer is available within 200 fee�.J--� <br /> (No septic tank or ces Spool permitted if public <br /> Septic Tank: distance;from nearest well_________________b1stance from foundationw._.;-------------Material__________________--__-__--_-------------__- <br /> No. of'compartments------------------- ----------------------------- <br /> ---Liquicl'depfh------------- _---------Capacity----------------------- <br /> P - S <br /> Disposal rffl G� Distance from nearest we]----- Distance from founclatio __/_0--------�_.Distance to nearest lot line-47/------ <br /> .�e 0�f I <br /> N -------Length of --14widfh of trench_,�,a2le <br /> -- ----------------- <br /> ---Total length--- --------------------------- <br /> u�nher of lines------ I-------- ---- each line---a-d-------0-- <br /> �Z, Depth �� filter �naferlal_ <br /> il;��,Ype of filter ma <br /> Al <br /> See�age Pit- Distance-to nearest well---_----------------------Distance,froj' f unclatior......./......_`_Total <br /> to nearest lot lihe-;C1------ <br /> , P. 0 <br /> 44 ------ <br /> Number of pits...... --- ---Liiiing material---,.. ir `..Size: Diameter__: <br /> i Ir <br /> Ces5pool',_ Distance from nearest well--- ----- --Distance from foundafioi----------------I.-.Lining material------------------------------------- <br /> ❑ S;z'e: DiAefer__ ------------------ -----De pth-------------------------------- '-Liquid:Capacity- '.---------------gals. <br /> Privy: Distance from nearest well-------I-------------------------- -------------Dis�anle---from__n_d�res+ buirding_Z.-`�------------------------:7---- <br /> 1 ' - ----------A--------• <br /> I I : 1-1-1 , 0 <br /> ❑ Distance to nearest lot line------------- ------ ------------------------------------A--------_-------------- -------------------------------------------------------- <br /> '010000, >_ .. , <br /> 40- <br /> '; <br /> Remodeling and/or repairing (describe):----__-- ---------------45:Z111115�. .4, ----o -- -- --- <br /> '000 <br /> ------------------------------- --------------------------------- ------------------------------------------------------------------------------------------------- <br /> ----------- ------------- <br /> ----------------------------------- ------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- <br /> --------------------------------- -----I---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that have prep a red'th is'-a-o`pi icati-o-n-a'bi'�'I-th atzthI6-w6rk­wi I I mbe-done yin accordance with San Joaquin oun y <br /> laws;Aaqd rules I ti ' of the San Joaquin Local Health District. <br /> ordinances, State ]a ru es and a ions <br /> [Signed -----------14 ;6_1 ----------------------------------------------- (Owner and/or Contractor) <br /> By:------------------------------------ - ------ - ----- --- --------------------------(Title). ..................... <br /> (Plot plan, showing size'of Ibf_"Ati,tion of system in relation to uildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY I i <br /> -DATE--------- <br /> - -- - --- ----------------------- <br /> APPLICATION ACCEPTED BY ---- ------------------------- - - ------------------------------------ � i ----- <br /> ------------- --- ------ <br /> REVIEWED BY-------------4------------------ --- ---- ------ DATE------------------------------ <br /> ; - ---------------------------------- --------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------- ------------------------------------- E-----------------------;;----------------------- <br /> Alterations and/or-recarnmeiidafions_ <br /> --------------------------------- ------------ <br /> --------------------------------------------------------- --------7777-7777 - --------- ------------------------------------------------------------- -------------------­-- <br /> ------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- -------------------------------I------- ---------------------------------------- --------------------------------------------------- - ------------------------------------------------- <br /> ----------------------2 -------------------- -------------------- ------- <br /> ------------ .......... ------- ------------- ------- ------------- ------------------------- <br /> :;-------------- <br /> e?_ <br /> --- Date_.-.-.-71- ---------- -------------------- <br /> FINAL INSPECTION BY: Ir <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton AresV 300 W�",'k Street 124 Sycamore Street 205 West 9th Street <br /> I A0 . . A '. ) � -t. w-• , , <br /> Slacklon,California Lodi, California Manteca,California Tracy,California <br /> F,P.CO. <br /> Ai <br />