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FOR OFFICE USE: U ----------- 4-3 0 - M_.�... - -- ------------------------------ ---.----------"-.. APPLICATION FOR SANITATION PERMIT Permit No. .._...-.---0..6__6 ---------------------- --------------- ------ ... (Complete in Duplicate) 14 _:, ;.._ 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------- . 3� ___ _ N may,� Owner's Name �f•1 ---- ----------------- -- -------------------- --------------------------- Phone---'��G = / ----- Address -----•----------------------------------------- Contractor's -------- ---------------------- Contractor s Name----------------' t ----• -------------------------- --- •----•-----.------- -----•---•-----------------------:-------- - -----••----- ------- Phone. � � y� Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units __/__ Number of bedrooms __oZ Number of baths_Z__ Lot size _______ _ _------ Wafer Supply: Public system [Community system ❑ Private ❑ Depth to Water Table %�.a_ ft Character of sail to a depth I`f 3 feet-" Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ ,r TYPE OF INSTALLATION A'ND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �. Septic T nk: Distance from nearest well)/�r Dist an� from foundation--./Q------- Material_ '_ � i P __C_2------------- ---Liquid depth 7 No, of com artments_--_- -5i ---- ze'��__��1_��"1.� - ` Disposal Field: Distance from nearest well-30ha....Distance from foundation---1.4_--___._-Distance to nearest lot lind_S------!V [ Number .of lines ------1---.---- Length of each line-_910.... --__---.....Width of french____��'----------------- Type of filter material.�+�!_.. .�5!-V--._Depth of filter material-__ __--------Total -------- Seepagelength-------9Q-' it: Dufabncce: nearest well_ Linin matf m foundation---/4_ _____.Distance to nearest lot line__4C. a� Ir ,t ---Distance erial____ �_-_� R p g 5-C''---__ Size. Diameter.�J✓�_..._..._-_Depth----- -,5___________________ Cesspool: Distance ,from nearest we!! ----------------Distance from foundation----------------- ..Lining materia!__.__.__-___---___.____...____..._. W ❑ Size: Diameter- -- ----- _..Depth------------------------------------------ -------Liquid Capacity--- ----------------------..gals. + - - v 'I r Privy: Distance from nearest weli------------________________ :_ -__..____. .____._Distance from nearest building------------------------------------------ ❑ Distance `o nearest lot line---------------- --------------- ------ ----•- ------------------------------------------- -------------------------•---------------------- „4 Remodeling and/or repairingII (describe):-- ----------------------------------------------------------------------------=---------------•-----------------•-- ---------------------------- ---------------------------------------------------i---------------------------------------------------------- ------------------------ -------------------------- -------------------------------------------------- - U 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 o the San Joaquin Local Health District. I # Y c (Signed)--- - --- --- - ---------------- --- ----------------- -- Owner and/or Contractor) By:-------------------------- - ------ -- - ------- --------------.R. ------1------(Title) . ---- - -- -- --- --------------- - (Plot plan, showing size of lot'; location ofxsystem in relation o wells, buildings, etc., can be placed on reverse side). I, FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED B Y ---- --------------- ---- -------------- DATE- 9 6 j ---------------- REVIEWEDBY -------------- 'M------------------ ------------ --- --------- ---------------------------- ------ DATE-------------------------------- ----------------- BUILDING PERMIT ISSUED- ')---- --- --- ------- -------- ------ ------------------------------------------------------- DATE----------------------- - t a -- --lotions• ------------ ------/----------- t Itera�on. and/o -77__Ini ....- {,c += - - - ----------- - .. i� ivf]"� -- ------ - -- ------------- ---- J r r!'E hf yl t`t �Q � ��fF" - ---- ------- ---------------- ---------- - --l ---- - ----------- ------------- i ii l FINAL INSPECTION' BY:_11.' . __ ----------- --------- Date-- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5locklon,California I Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press f l�