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FOR OFFICE USE: 3 -______________________.---_.-.._-._-----.-----._. APPLICATION FOR SANITATION PERMIT Permit No. --._- .�..�C�4r- w (Complete in Duplicate) 7� --------- ----------------------------------------------- ---.--- 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 h describe This application is made in compliance ith Count Ordinance No. 549 JOB ADDRESS AND LOCATION = --------- ---------------- � ----- --------- -- - -= ,- / � � /. Phone /7Z .3 - -- --- �_ - ddress_ Contractor' Name------ - ----- --------- ---- --�-i-------------------- -----Y---- Phone.. Installation will serve: Residence E[---,1Cpartment House ❑ Commercial ❑ #Trailer Court,E] Motel ❑ Other Number of living s�_-- Number of baths__ ___',Lot siz units- __ Number of bedrooms :-- _ e,____.1x-------------------------------------------- Water Supply: Public-system- ❑ Community system ❑ Private Depth toZ. Water Table-,L�_ ft. Character of soil to a depth of 3 feet: Sand' Gravel ❑ Sandy Loam ❑ !Clay Loam [] Clay❑ Adobe❑ Hardpan [ F. Previous Application Made: {If yes,date--------------------j .No ❑ New Construction: Yes �]' No ❑ FHA/VA: Yes ❑ Na:� V TYPE,.OF INSTALLATION AND SPECIFICATIONS: I• / -" (No septic tank or cesspool permitted if public sewer is available within 200 feet) I _Septic Tank: Distance from nearest well-_��--_ -_Distance from foundation ___�y No.}of compartments--_� r SiSize_ YS X Liquid de th-_---- CaacitY_1a + � _ _ . _ P �� p : Distance from nearest well— d.t Disposal Fieldt" }' p .. _ Distafl'ce from f"oundation� �.-__._-.pistance to nearest log line-----------:_5_ Number of lines______ .______ - t .Length of each line__ _0 �� Width"of trench.-_13-___ __ / i . _ De th of`.filter material -_ :- _ .Tofel`len th_`_____ _o'___------------. # Type-of filter material.--,5/ _ p4 `Y '" gl ❑ pits-0 rest well-----------------------Distance from.foundation--------- .Distance to nearest lot line__._-_'_:______ -- -------------- g --------Size:tDiarneter'�.-- p Linin material-- - - - ---- ---------=------De Depth--.,-. :-_-----=------- Seepage it: � Distance to nearest Cesspool: Distance from n um er o p nearest well-------------------Distance from #oundation_- _- :_--.-_.Lining material---------------_-..----.__-____--. Size'l Diameter---f---------------------.----- -De th-.--.--------------.---- �Li Liquid Capacity f - k ---- p ------------- - - -� -- q - --------------------------gal{ Priv -Distance-, nearest wO---------------- pistance from nearest building g---------------------------------------= ❑-, Distance_ to nearest lot line----------------- ---=-�_- ""„----------------------------------------------- ------------ Remodeling and/or repair.i'ri'g'-(describe)------- ------------ #---------------------------'---- r ---- -------------•----------,-----------------==--_----- ------- ---------------------------- s 1 r -------------------------------------------------------------------- - - 4 - - _ _: = - z` - =_ ------------------------------ ------ = - ;.------'------------------------=-•--^^---------------•----------------------- ------------•---- I hereby certify thatI have`prepared'this application-and_fihat_the r'ork.,will be done in accordance with San Joaquin County ordinances, State aws, and riiles°'and regulati s of the San Joaquin'Local Health District. x R (Signed)-- ------ _al"j ----- i'. -------------- -------------------- ,-r BY --- '---------- - -------- (T1tle --(Owner ------ -r Ca-------- - s_ w rand/o Contractor) „ --------- -(Plot Plot elan, sh6Win' size of ot,.looation,of 'stem in rely#ion to'w' s,-'buildin s, etc., can;be' laced=on reverse-side� -=- .,...._ 'FOR DEPAR ENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- ell ---------------• = i DATE REVIEWED BY` - - - •-_ -------=------ ----------- DATE----- BUILDING PERMIT ISSUED ----------------------------'----------- = -� DATE.• - Alterations and/or recommendations --------------------- ----------------------- ----------•-----------------------------------------------------------••------ ~---------- ------------------------------------------------------------ - ------------------ -------------- -------------------------------------------------------------.------------------------------------------------- -------------------------------------- ----- ---- ---- ------)---•=-----------------------_---------=--------------------------------=---------------------------------------- �fINAL INSP7 -- - `1.� � r Date----------- � -w- ISAN .' JOAQUIN LOCAL HEALTH DISTRICT I 601 E.Haaltore Av4. ; - 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockton,California Lodi,California fit, Manteca,California L � � � -., 4 gip.. Tracy,California E5 9 REVISED 5-59 3M 3-'63 P.P.CD. "_��