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FOR OFFICE USE: ��& 1 --.--..--- -------------- ___- /i,'�cV APPLICATION FOR SANITATION PERMIT Permit No. _ 3 --- -- --- ----- --. -- I` (Complete in Duplicate) / -.-.. __ _- This permit Expires 1 Year From Date Issued_ Date Issued d__S�-� 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. ---------------------------------------- Owner'sNamo__/_ ` - .!<-/�---/_ -��= ----�- ------------ - - -------------------------------------------- Phone------------------------------------ - Address__.. -------------' �_&Z_4 %k_ ----------------------------------------- - Contractor's Name------ ` ----------------------------------------------------------------------------- Phone--------------------------------- Installation will serve. Residence V4-�—Apartment'House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E-]Number of living units: __ �_ Number of bedrooms..-.-.. Number of baths ___ -_ Lot size Q_ �-_ _ l�------------------------- r n Water Supply: Public system Community system E] F'r-ivate E] Depth to Water Tablea-Q ft. � II ; Character of soil to a depth of 3 feet: Sand ❑ Gravel1E'] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe.93-17;ardpan ❑ Previous Application Made:# (If yes,date----------- ------]-• No [Pr`New Construction: Yes ❑ No "FHA/VA: Yes ❑ No [5--. TYPE OF INSTALLATION AND SPECIFICATIONS-' (No septic tank oro esspool,permitted if public sewer is available within 200 feet.) TanDistance from;nearest well----_----- -- Distance from foundation_____________ _____ Material__'.----------------------------------------------- } ( No. of compartmems--------------------------Size-----_-----_-----------------_Liquid de th---- -------------------_-Capacity nearest well---- ----------Distance from foundation____X147--_. Distance to nearest lot .--- '� � s__ - -- "- _-- _-.--- ength of each Iine___ �Nidth of trench.. _:l.f..___�------------ Dis osal Fie 1.. Distance from Number of line Type of filter material-- Depth of filter material__ , .-_�-__.Total length__. �"f� teepage Pit: Distance to nearest 'ell--_+ _____Distance fr m fou dation_J70_-__-___ Dista---_e to nearest lot Number of pits_ _ W� -----Dth- s ,a '+ Size: Diameter_-- yrest weif__I_____________Distance from foundation___._--__---_____._.Lining material__-_---__-___-__________-___�____._-.. ❑ s -[ f Cesspool: Distance er e ---ea----------------- ------------Depth---------------- -----------------------------------Liquid Capacity -gals. Priv Distance from i ti. . '� Inea�est well-------- ..._Distance from nearest building -.____.-. ❑ �x t Distance to nearest lot Ilse ---- ------------------------- ------------------------ -------------------------------- --- }. u Remodeling and/or repairing (describ;):__-_---- ____.__,> __ ---------------------------------------------------------------------------------------------------------------------------------------- -- ----I-- —-----------------1------------------------------------- -- } 1- r, t r r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Corinty ordinances,'State laws, `and rules Snd regulations;of the San Joaquin Local Health District. .{Signed}----------------- -------- - - �--�(1=-----7��_ �- -- - ---- ------------------------------------------------{�r Contractor] By: ----------------------------------------' '= ------ - - -----------------------{Title} G' �' - -------- ,(Plot plan, showin'` size of lot; location of sysation to wells, buildings, etc., can be placed on reverse side). Y (FOR 'EPAR MENT USE ONLY r APPLICATION ACCEPTED BY----------------- r �i , ------ DATE----1------- -L67----------- REVIEWED 6Y ------------------------- -------- ---------------- DATE- -------------------------------------------- BUILDING PERMIT ISSUED---------------- I DATE_ ----- -ma- - Alterations and/or recommendations:-_-_--_ -- �_ s __ ___________________.__-. -------•--•----------- -------------------------•--------•------ ----------------------------------------------------------------------------------------.-------•----------------------------•- ---------------------------- -----------------------------------------------------------------------•----------------------------------•------------------------------------------------------------------------------------------------------------------ ------------------------------------ ---------------------=-----------=---------------------------•--•-----------•--•----------------------------- ------------------------------------- ------------------ --------------- FINAL INSPECTION BY:.--- 4�f f,f� -of T--------- Date...... __4617------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT A , 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street's 205 West 9th Slreel slocklon,California Lodi,California Manteca,California Tracy,California } , F.P.CC. 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