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F R OFFICE=USE: <br /> 3 <br /> -6, APPLICATION FOR SANITATION PERMIT Permit No. .__...__._ :��..7/ <br /> ------ - ---=-------------------- -------- <br /> -------------- ---------- f (Complete-in Duplicate) Date Issued <br /> _-- This Permit'Ex Expires 1 Year From Date Issued <br />-- ---------- -------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. C: //r/7tifv atry-.•-- <br /> JOB ADDRESS AND LOCATION---/------------ "------- -- ° --------- <br /> Owner's Name------- -Z�-- --------- ----------------- - <br /> . Phone------------------------------------ <br /> Address-- ,---/-3P----'f--9-------- = ' ......------------------------------------------------------------------- ----------•------------•---------------- <br /> Contractors Name----------/1019710---=/._P10p7;'�-------- -------------- ---- ------- -------------- ------------ <br /> ------ Phone------ •--------•---------------- I <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Z__ Number of bedrooms j_. Number of baths Z.__ Lot size ---------------- <br /> i <br /> Water Supply: Public system E] Community system El Private �bepth to Water Table t--ft <br /> Character of soil to a depth of 3 fee+• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 23-"�ardpan ❑ <br /> Previous Application Made: (If yes,date--------- ---------- ) No [E' New4Construction: Yes gil-No ❑ . FHA/VA: Yes E�- No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> � <br /> -------M,t ria��lrem <br /> C�- <br /> Septic Tank: Distance from nearest well-.��_._Distan�ie from foundation___ .__ <br /> No. of compartments-.-,2rSizeJ�s -'.?k6 `*Liquid depth.--/� Capacity.pw.v--__- <br /> Disposal Field: Distance from nearest well_�L-----Distance from foundation..l�-------.Distance to nearest lot line_-4,7----_-. <br /> Number of lines-------- ----- ------_Length of each line--- f, -� -------"-- Width of trench_.t:?z- ---------------------- <br /> Type of fitter materiallj� pepth of filter material... �r -..___._Total length--.,R�_- <br /> Seepage Pit: Distance to nearest well_fQ-"--Distance from,,foundation__Za........Distance to nearest lot line--Ll ------ <br /> i <br /> L� Number of pits..-/-------------Lining material Q Size: Diameter�3..---- ---Dept h—a ------------------------ <br /> Cesspool: Distance from nearest well -----------.--Distance from4oundation------------..--- ..Lining material _._........--..---_____-------__---. <br /> Size: Diameter- - ------ ----------- Depth------ --------=-- -------Liquid Capacity- --------------------------gals. <br /> ❑. - --- -- - ---------------------- <br /> Privy: Distance from nearest well..................... ------------------ Distance from nearest building-__.__"--..---_--__---____---....._--- <br /> ❑ Distance to nearest lot line-----_------------- - ----- -- -"------------" --------- <br /> - ------------------- --------------------- ------------------------------------------- <br /> Remodeling and/or repairing (describe) ��F 1 .----5 --`5'/�f��� <br /> --------------- -- --------------------- <br /> w' ------------------------------------------------------------- <br /> -------------- <br /> --------------------- --- ------------- -------------------------------------•--- ----------------------------------- ---------------------------------------------------------------------------------------- <br /> I hereby certify that I ha`ve'prepared,this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of theSanJoaquin Local Health District. <br /> (Signed)------- ® --- ���f. ---------------( or Contractor) <br /> .- . ----------------- ---------------- <br /> (plot <br /> -------------(Plot plan, showing size of lot, location stem in relation to wefts, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 13Y_____________ __ g " " <br /> DATE.. /-- ----------- <br /> REVIEWEDBY------------------------ --------------- ----------------------------------------- ­­--- DATE----r- -----------------r----------------------•------- --- <br /> BUILDINGPERMIT ISSUED.------- -- ------------ - ----------- ---------------------- DATE------------------------------------------------------------- <br /> I <br /> and/or recommendations....._ . "" -----------­- <br /> SAa �i' - G' � --�, ------------ --- <br /> ------------ ---------------------- ------ ---------------------- ----------- ------------- .......... <br /> + FINAL INSPECTION BY-----..........C.,�----- ---- - ---- Date `s �7. -. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I 1601 E.Hoseltan Ave. 300 West Oak Street— 124 Sycamore Street 205 West 9ih Street <br /> stoektan,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />