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APPLICATION FOR SANITATION-PERMIT Permit No, (Complete i.n Duplicate) 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 PCATIO --------- ------------ -D--------------------------------------------- ------------•----------------------- -------------------------------------------------- _&------------- Owner's Name---------/it' 7*';- Address-------------- ------- Phone------------------------------------ ---------- -------- ------ --------------------------------------------- ------- ------------ Contractor's ---------------------------------------------- . Name------------ ----------I--------------------------------------------------- PhoneZ_-?k77------- Installation will serve: Residence Apartment HoCommercial E] Trailer Court E] Motel I XL 1_.Y. E] Other E] House El Number of living units: - ----- Nu'm'ber of bedrooms _P2-- Number Of baths _ _____ Lot size ----------------------------------- Wafer Supply: Public system E' Comrndn'i_fy' system El Private E] Depth to Water Table,-,5_0 ft.. Character of soil to a depth of 3 feet: Sand E] Grave);E] Sandy Loam E] Clay Loam E] Clay E] Adobe Rj`_ Hardpan 1 1 L ❑ Previous Application Made: Yes [-] 4No � New Construction: Yes [-I No Mo" FHA/VA: Yes ❑ No Ej TYPE OF INSTALLATION 'AND SPECIFICATIONS: (No septic tank or'c;sspool liermifted if public sewer is available within 200 feet.) 1 11- . .. A Apfiank: Distance from nearest well___-_.__-__-____Distance from foundation-------------- ------Material No. of Fcbmpar4nen[s_---- ------._--Size------------------- ---------Liquid depth---------------- ----------Capacity------- D' pos a I field: Distance from nearest well-- ------------.-Distance from founclation--------------------Distance to nearest lot line----------------- Number,of. lines---- -----------Length of each line-------------------------"WidW-6f'-f�e—nch Type of filter material-------------------------Depth of filer material---------- ------I .11-----Total length---- ------------------•------------- Seepage Pit rn� Dist ance-fd�'nea rest well��-------Distance�rom foundation____0� Distance to ne'arest'lot iine-_/0 Number ;f pits.- ------- --------------------------Lining maferial--WO-17-A-------Size: Diam'eter_'__*,-,33.' -------- ----- ec _------------ • y ' Distance from nearest well__---------------Distance from foundation------- I ------------Lining' material' El Size; Diameter_ - :----------------------- -------- ------------------------------Depth----------------------------------------1-----------Liquid Capacity-:--•--------------------• gals. Privy: Distance ifrom,.nearest well___-_--_--------------_----_------------------Distance from nearest building---j : - -EJ -Disfance'}o nealr' 5t lot lire-------- --------------------------------- e ------------------------------------------- ------------------------------- -------------- --------------- Remodeling and/or 'repairing (descri`b' e):------------------------------------------------------------------------------------ ----------------------------- -------------1-----------I - ------------- -------------------------------------------------------- -------------------------------------------w-------- ti ------------------------------------------------------------------------------------------- -------------------------------------------------------------I-------------------------------------------------------------------------------------------------------------------------------- --------- ----------------------------------------I-------- .1 -------------------------------- * --Zi--------------- -------------------------••-------•----------------------------------------------I---------------------------------------------------- I hereby c y that I hi'yepr,;�areid 4his_a_ li�afi;d-f�af the --k- -1 be done in accordance with San Joaquin County Pp on a work will ordinances, ?Stafe ws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- e�_35(------ --- - ----- .............. . ........ (Owner Snd/or Conirac+or) 6N.. dings, etc., can e.rplaced on reverse side). ----------- iz --- ------------ -- -----------(Title)----------- -- -------------------------------------- By:------------- (Plot plan, showing size of of, loca Jon of system in.relation e S. buil .......... C FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__.._____ __,--_______ -------------- DATE------------ -- ------- -- ----------------------------------------- ' _7'1_1�_11 �-------- REVIEWED BY------------------------------------- .1. ----------------- DATE-b-- --- --- ------------ BUILDING PERMIT ISSUED----------------- 10 -------I.,----------------- Alterations and/or recommendations-.-'------ -- -------- -- ------ ------------------------------_ DATE-------- 21--------:----------------------------I-------- ---------------- - ----------------------------------I-------------------------------------------_ .......----------------------------------- A-LV- ------------ e-ZI-114------------ ------------- i-------- ------------ ----------------------------------------- --- ------------------- ------------------------- -------------- -----------------------------------1-------------------------------------------------------*---------------- -------------------------------------------- FINAL INSPECTION BY:----- - --- -------------------------- Date_....--_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+.Qckton, California Lodi, California Manteca, California Tracy, California ES--4-2M Revised 1.57 F.P.CO.