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FOR OFFICE USE: Z ------------------------------------------------------- APPLICATION FROR SANITATION PERMIT Permit No. ............................. ----- - - (Complete-in Duplicate) r Date Issued This Permit Expires 1 Year From Date Issued -- -- = 7 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 LOCATION... -� ------ �'H a.�► Owner's Name Rl - � . ; - Phone-7— Address hone ---- ---- - Address--------------------- �67.1-----------•---._ rt --------- Contractor's Name---- ---�}-t .tf-- - �s�! --s T --- --------- Phone.$4_6._j.J0�/__._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms._ Number of baths/-____ Lot size _ ________ _____ _ - ------------------------- Water Supply: Public system ❑ Community systern ❑ .Private Depth to`Waterjable ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Laam ❑ Clay Loam ❑ Clay ❑ Adobe M-_'Hardpan Previous Application Made: (If yes,date------------------- ) No ❑ New Co�4fruction:- Yes.❑ No - ,FHA_FHA/VA.. Yes ❑ No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ce: Isool pe�mitfedtif publid sewer is'availab a within 200 feet.) a*� S Ta k Distance from nearest well............... Distance i-M foundation_____._.__�r.Maferial ___._ ___.,._` . No. of compartments-.-- .. ...... ..Size------- - ------ -----------Liquid clap;- ----- --- -- ---- ---Capacity-------------------- ,. �'J`� �`� � Distance to nearest lot line__ � Di sal Fi Distance from nearest well.. __ll/.. ....Distan-e~Y.from foundati n___.__ �_____.�, Number of lines - i - Lengthlof each line__ .. Width of trench.c��.*�________________J. - ��}- Type of filter material. Depth of filter material_____ ..__._.._dotal length_______________ -D--------.- a e it: Distance to nearest we ___:•._..._Distance ff m foundation____��_ ..Distance to nearest lot line--._ __ p� Number of pits.__ 1___._..._.._.__Lining material___�C----___ Size: Diameter._ ......Depth_irL... ---- ----------------- Cesspool: Distance from nearest well ____- _Distance fro foundation____.---- ------ _ Lining material..........._------------------------- • *�, Size:'Diam�atm er---- ------- ---I-----------.De th_--------------.---.--- Liquid Capacity gals. � Distance from nearest well ____...._._.-_.___. PrivQDistance from nearest building____._-_____._.___._________..._......... � Disfarce fo-,.n a est lot line _______________________ . _.. Remodeling and/or repairing (describe): {- -- $ ----- tM ----------- ---------- --------- ----------------------------------- -- -------------•-----------------------------------•-•------------------------------- ---------------------------------- - --------------------------•---------------------------------------------------------------------- ......... I hereby certify thafJAevea-prepared this application and that the workwill done in accordance with San Joaquin County ordinances, Stat an rules d regulations a San Joaqu' Local Hea District. (Signed)----- L 4 Contractorl 7,4e 4_� By----------------------------------------------------------------------------------------VY -- ----(Title)--------- ----- ------- (Plot plan, showing size of lot, location of system in relation t wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �I APPLICATION ACCEPTED.BY------ --------- ---- ----- ----------- -------------- DATE------ 1... - REVIEWEDBY--------------------------------------------- ----------------------------------------------------------------- --------- DATE.----------------------- BUILDINGPERMIT ISSUED-------- --------------------------------------------- -----------------------...--------------------- DATE--- -------------------------------------- ------------------ Alterations ---- - --- ------------------ Alterations and/or recommendations------------------ -------- ----- --------.--------------------------------------------- ----------------------------------- ---------- - --------------------•---------- -------------------------------------- ------ ---•------ -------------•------------------------------------------------- -•---- ------------------------------------------- FINAL INSPECTION BY:.` _- -( , ---------- Date----- (-.--1. 5 - SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press