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FOR OFFICE USE: �V <br /> ---/`3 <br /> . _ APPLICATION FOR SANITATION PERMIT Permit No. �. =... .__ <br /> -- <br /> (Complete-in Duplicate)t . . S <br /> phis Permit Expires 1 Year From Date Issued <br /> Da+e Issued <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 ma a in com Pian with unty Ordinance No. S49. (vS, D 3 D -2-0 <br /> — <br /> JOB ADDRESS AND LOCATION--------- "------- ---------- ------------------ --------- <br /> = ' �.------ - - ---------------------- -------------. Phone <br /> Owner's Name ---- ---• -- tp.�3- -------- - --- <br /> Address-----------a-Z9-%----------MI.- i4_ '.... ' -----------------------------------------•--------------------------------------------- <br /> ----------,- ------------------------ <br /> Contractor's Name �'e' --------- ------ Phone. -------- <br /> } <br /> -� <br /> Installation will serve: Residence E] Apartment House ❑ Commercial ❑ Trail r�C ur 11 Motel ❑ Other <br /> Number of living units: _. .._ Number of bedrooms ........ Number of baths/------ o ¢e ----- --- -------- -------- -----------_-_--_....._.._..-- <br /> Water 1, Supply: Public system ECommunity,0stem ,Q Private ❑ Depth to Water Table"-� � ft� � i <br /> Character of sail to a depth of 3 feet Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No Ce"'New Construction: Yes P4-"N' o ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> I ( ----(No septic tank or cesspool permitted if public sewer is available within 200 feet.)j <br /> S tic ank: Distance from nearest well:_Distance from foundation__`4 Material gal--.._... __ _________ __________________ <br /> No. of compartments_.____, .-/f�?l . _ Liquid depth_ .-.-. _---_..Capacity--- <br /> ------- . . y <br /> Dispo I Field: Distance from nearest well 4--_Distance from foundation��.----------Distance to nearest lot line----------....- <br /> �! <br /> Number of lines_--____..__/.-____ _ ______pp._Length of each line__. .*-0--f..--___._.Width of trench_..._ - -- --------- ----- <br /> Type of filter materiai.__:r1?V,4r -LDepth of filter material-- ` -------- <br /> ----Total length_____________________ <br /> Seepage Pit: Distance to nearest well'�1,e -Distance rom f/o>unt]ation--_._�Q_..---.Distan,a to nearest lot lin_er_. .___._ <br /> Number of pits------/_ -----"--Lining mate rial��.�±-[.C�-- Size: Diameter-.��-.-tf.. Dept h......�7------------------- <br /> Ce�spool: Distance from nearest well ..._-_----.----Distance from foundation................. ..Lining maferiaL...-__--------__--._---._...--._...-. <br /> ❑ Size: Diameter- -- -------------- --------------.Depth------------------------------------------- ------Liquid Capacity. -----------------------gals. <br /> Privy: Distance from Inearest well-----__-----_...-.--_--------------------------Distance from nearest building----------------------------------._.._._. <br /> ' ❑ Distance to nearest lot line .....-__-------------------- -------------------------------------- <br /> Remodelingand/or repairing (describe)--------- ------------------------------------------------------------------------------------------------"----------------------------------------------. <br /> C ----------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- <br /> ------------ -- - - Pi-----------------------Pp----------------------------.-----------------------;--------------------------------------------------------------------------- - -\1 <br /> I herebycertifythat I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws and rules a re lations of the S n Joaquin Local Health District. <br /> % a � <br /> - _ - _ Contractor) <br /> (Signed) -- --- --- ----------------------P,­_�. nerr- d/o orBy --- ------------------------------------ -----•---------------------- ---� ------- � _(Title)---. - --....... <br /> (Plot plan, showing size of lot, location of system in rela ' to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ----- - ------------- ------------------------------- -------------- DATE-- ---------------------------- <br /> iREVIEWED BY----- - ------ --- ------------------------------------------------- -----------------. DATE-------- ------------------------------------ -------------- <br /> BUILDINGPERMIT ISSUED-------- -- --------------------------------------------------------- -- ------------ ---------------- DATE----------------- ------------------------------------------ <br /> Alterationsand/or recommendations:------- ... --------------- ------ ----------- ------------------------------•-------- -------------- ------------------------------------- <br /> t ------------------ <br /> ------------------------------ ----------------------- -----------------....--------..................-------------------------'---'-'-'------...._.---'----------------I-----..._—...._..-_...----------------- -------- <br /> .. ......-------------------.-_.-----------------.----_-.........._.-_..._...._. .-_...._.---------------------------------------.-------------------•--__.._..------___.....-.-.-----___.......-------------------------' -. <br /> FINAL INSPECTION BY:- - Date------ ... = 7-. '----------- - --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Na:eltan Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Slocktan,California Lodi. California Manteca,California Tracy,California <br /> E.N.9 21A 1.67 Vanguard Press <br />