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t FOR OFFICE USE: q <br /> I <br /> --- . ----------- ...... - - ----" <br /> APPLICATION FOR SANITATION PERMIT Pe <br /> rmi# No. _�...._..-Y..�� <br /> h <br /> C <br /> ') (Complete-in lete•in Du eate / S <br /> ( P Duplicate) Date Issued ....�.�......._�J <br /> - ........ _;II This Permit Expires 1 Year From Date Issued <br />' Application is hereby made to"the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in cori':pliance with County Ordinance No. 549. <br /> JOB ADDRESS AiJQ LOC Ti . ._'��..K x...C�FN/..L. " fr±�°'/dr?klIVka_-.----- W'Cr.._................... <br /> r <br />' Owner's Name..._........_. ................... ..:......................._..............._...... _. -.............Ph <br /> Contractor's IName................... .. Phone--- ----- <br /> Installation will serve: Residence Apartment House [ICommercial ❑ Trailer Court ElMotel ❑ Other C1 <br /> Number of living units: @fit@. 1_. Number of bedrooms ...•�'-.. Number of baths .....). Lot size .....0JSL�IoI�,.---------------------- <br /> ' Water Supply: Public system i❑ Community system C1Private ElDepth to Water Tablet. _ f+ <br /> 5 <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel E) Sandy Loam Clay Loam ❑ Clay El Adobe❑ Hardpan❑ <br /> Previous Application Made: (if yes,date................... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> 1� rTYPE OF INSTALLATION AND SPECIFICATIONS: <br /> _ . ..- <br /> (No septic+ankar,cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance fromfoundation...................Material................................................ <br /> ❑ No. of compartments..._.-...................Size........ -----------Liquid depth---..... . ... ......_Capacity...----- --- <br /> Disposal Field: Distance f1om nearest well---411_.._.._Distance from foundation..!:1...a .. <br /> _.-------.-Distance to nearest lot line... ...-_..... <br /> Number of lines...........1.....................Length of each line.......6!°...............-Width of trench...`7-4. .................-------- <br /> ' yp ter material..f), . .-.___...Depth of filter material__...:�g._....... length_...(9..Q_.__................_.....__ i <br /> A e rt• Distanceter <br /> nearest well.g.QA.........Distance from oundation_ ... <br /> . ..........Distance to nearest lot line..°v .......... r- <br /> ❑ Number of pits.........1...........Liningmaterial..'.�rr ..... Size: DiamL?......Dept h.....�44,---....... <br /> -.---- <br /> 1 <br /> ' ❑ i,om nearest well ..............- ......... - -__- <br /> Distance from foundation material--------- _ <br /> - ------- <br /> Cesspool: Size:Distance <br /> 4iAter-.. .............. ................Depth...................------.........................Liquid Capacity............................gals. , <br /> Privy: Distance from nearest well..............................-------........._Distance from nearest building-----------------...--------.-.-------_ <br /> ' ❑ Distance to nearest lot line ----------- ..--.-...............---.............__......_..---.....---........._.......---------..... <br /> Remodeling and/or repairing,(describe):................----- ------------------------------------------_---------.......................................................................... <br /> 1 <br /> . --•-•-------..............,_.__........._ __ ... <br /> .. .....---............ ..__...._....- <br /> "------....--"------......—... -------------..................—'_......... ------ ............_c_.-..........--............._.. <br /> ...................--- <br /> { <br /> I hereby certify that 166 prepared this application and that the work will be done in accordance with San Joaquin County <br /> ' <br /> ordinances, <br /> -�State <br /> "la'ws.a d rules and regulations of the San Joaquin Local Health District. <br /> 1 <br /> Sine ... ...6.,,✓''Pf... (,est.., : .e.. ...........---.....................................-�....(Ownor- and/or Contractor) <br /> :..:, .By:...............:........ _ r----- (Ti+le) <br /> (Plot plan, showing size of lot,11location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> < FOR DEPARTMENT USE ONLY <br /> ' APPLICATION ACCEPTED BY._...... DATE DATE_, .^.. s. �------------------- -------- <br /> REVIEWED BY........................;............_..... _..... <br /> ... ........-_...........-,.....,...._............. ............... <br /> ---------------------------------- <br /> BUILDINGPERMIT ISSUED---I................... ------------------------------_..............--..................... DATE----...........-------_----------------------------- <br /> t Alterations and/or recommendations:_...........................................-....................._......._................................`............... ..................... <br /> r ----------------- ...................-.......----.----.....-------- <br /> .......................... ..................... <br /> .................................. .................................................................... <br /> 1 . ....__....... ...... <br /> ... _. - <br /> . -- <br /> FINAL INSPECTION BY:__ fr�7h ------------------- Date.t�.p r �4.E....----------....._------...................... <br /> ' 9 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I601 &Nardsan Ave. 200 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> ' I <br /> S<o<klan,California Lodi.California Manteca,California Tracy.California <br /> E.H.92M 1;07 Vanguard Press I <br /> n x <br />