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FOR OFFICE,USE: , <br /> J C-__ r�. APPLICATION "FOR SANITATION PERMIT Permit No. .__l..______.._..... <br />-----------11 Jr' '` f�'��- (Complete in Duplicate) Date Issued .f /-- <br /> -------------------------------------- -------- This Permit Expires"1 Year From Date Issued s : <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construcf.and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. r� <br /> S �� <br /> N� �'` ' <br /> JOBADDRESS AND LOCATION--------- - -- -- - - ---------------------------------­­-------------------------------- <br /> Owner's Name------------------ .-------� ------------• -------------------------------------- -- --------------------------- Phone-------------------------------- <br /> Address-----•------ -------------------------------- --------- ------------- ----------------------------------------------- <br /> ------------- <br /> en <br /> ------------------•-----------------.-----•--- <br /> r ` <br /> Contractor's ,Name--------------------------------- <br /> Installation <br /> -- ----•------------- Phone <br /> Installation win-serve: Residence Apartment House ❑ Commercial ❑ Trailer Cour; ❑ Motel ❑ Other ❑ <br /> Number,of living units: ----- _ Number of bedrooms -3- Number of baths _1.--- Lot size _r -_X--_ ---f 5 --"""-- <br /> ,Water Supply: Public system ❑f Community system F] Private �epth to Wafer Table .�rft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> . Previous Application Made: Sof yes,d'ate--------- )� No 10/� w Construction: Yes ❑ . NoA/VA: Yes ❑ No [�4--Y-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: t, Distance from nearest well----------------Distance from foundation-..-----------------Material---------------------------------------.-- <br /> �� o. of compartments-----------=-_----- � Size ' � -Liquid depth----------------------�--Capacity- z �. <br /> �r (i ri - _ w <br /> Disposal Field:, -stance from nearest well.-------- 1...Distance from foundation <br /> _______________Distance to'nearest;lot line___________._____ <br /> unib-0r'of i i n s_- j_-_-'- ----=-------------Lengfh of each line-----------------------------Width of trench----------------------------------- <br /> ------------------------- <br /> y <br /> -------_-------------------------- <br /> . y _ - <br /> �/ }} ype of filter material--------------------------Depth of filter material-----------------------Total length-----------_.-----_-----.-_.-.-.___--_-_- <br /> Seepa it: I W istance to nearest ell_ C.�_:t�bistance om fggundation-_/_4._�.____.Distance to nearest lot cine-_-��.... <br /> umber of pits........--.----_---Lining'material___ �[. -_Size: Diameter--_ _�-- .....Deptn_ _._ ----- <br /> Cesspoo' Distance from nearest well-------------------Distance from foundation--------------------Lining material_-_.-.-_-----._ <br /> ❑ Size: Diameter-------- ------ ----- ----------------Depth--------------------------------------------- --.-Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well-------------________--_---._--..--_._-_.--_Distance from nearest building---.----------------------------.------ <br /> . <br /> ❑ ----------------------------------------------- <br /> Distance to nearest lot line ---------------------- -- ------------------------------- --------------------------- <br /> Remodeling an for repairing {describe}:---- - - € � 7 - - <br /> ------------------------ ---------------- -------4-----------------•------------�-- ------------- ------- <br /> ---------------------- ------------------------------ --------- ------------------------------------------------------------------------------------------- --------------------•------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. <br /> (Siigned)---- -•---- ------- . ¢ --- - (Owner and/or Contractor) <br /> By:------------------------ - - ---- -------- --- ---------------------------------------------{TitleP.- <br /> 4, (Plot plan, showing size t, location oin f system relation to wells, buildings, etc., can be laced on reverse side). <br /> ! FOR DEPARTMENT USE ONLY <br /> 1 <br /> APPLICATION ACCEPTED BY. --- .----- -- -------------- DATE----�' -----�----- __ - <br /> x <br /> DATE - <br /> BUILDING PERk4IT ISSUED---------------------------------- ---------- _ <br /> REVIEWED BY------------------------ - <br /> pATE -- ------ <br /> Alterations and/or recommendations:._..-_ ___ Com={ -�----- -- L T ` '' r <br /> / ... <br /> fir`' r <br /> --------- ' . <br /> ♦ /a <br /> ......----------------- - - <br /> t <br /> -------------- <br /> ------------------ - <br /> - -------------- ----- <br /> //�� �re <br /> i r FINAL XNSPECTION BY:..: - ate-------------- <br /> 'may-------- i_.. .._ ---------------------- 1 I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT. <br /> 1601 E.Haselton Ave. 300 West'Ook Street 124 Sycamore Street 205 West 9th Street <br /> Stocklonr California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. - <br />