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FOR OFFICE USE: <br /> - .:..... <br /> .......... <br /> - t <br /> .................. APPLICATION FOR SANITATION PERMIT Permit No. <br /> --- -! <br /> .................._.....--................------..... (Complete in Duplicate) <br /> - -- -------- ---- ----- This Permit Exoires.l"Yeai From Date Issued Date Issued <br /> Application is hereby made to fhe 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. S49. t <br /> t 2167O(— / 30 -` <br /> JOB A�DRESS AND LOCATION._1",!-t, •rz. <br /> Owner's Name.--0 J <br /> (/Inn a�r�...--- �yy- - .... P-1-11-1- <br /> .... ..... Phone............................. <br /> Address......P-7A... .�.-:r---....40: 1.------. .. .. <br /> iy�yy' <br /> Contractor's Name '........ - ............. %V.__ .f!..._�.fy�. _.._�F.. . Phone----- ......--------------- <br /> Installation will some: Residence ® Apartment House F1 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ./..... Number of bedrooms 3.... Number of baths .e%a.. Lot size -�...... ....................................... <br /> Wafer Supply: Public system ❑ Community system ❑ Private E] •Depth to Water Table/....--. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam] Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dote........ No ❑ New Construction: Yes ❑ No.❑ FHA/VA: Yes ❑ No❑ <br /> TYPE OF.INSTALLAT40N.AND-SPECIFICATiONS:4 - = ',-- -- --� ►-- - <br /> (No septic tank or cesspool permifted if public sewer is available within 200 feet.) „S <br /> ., i <br /> Septic Tank: Distance from nearest waII.�TA......-_Distance from founds+ion...tt-........Material..... <br /> Cf1:'�................... ( <br /> No, of compartments.... ..�1....._..........._Size.. .f'�Z.t .,. -Liquid depth__..Y....._........_Capacity.1�!"..dt:t.+_._ <br /> Disposal Field: Distance from nearest well.rib.........Distance from:foundotj�on,.L,.:.-_.._Distance to nearest lot line_,_-....... }l~� <br /> -� Number of-lines..-'...........:.......... .. .Length of each line:...dd."".d-....._..._...-.....Width of trench.. .4�!.:.-.----...._......-.. I,J <br /> Type of filter matetial' ... -Depth of filter material..,/?1K......----Total lengfh.. 'A...�A'..:.__................... 11 <br /> Seepage Pit; Distance to neares± cast..y._..--._........-Distance from founds+ion-----...............Distance to nearest lot line................. {� <br /> ❑ Number of pits... :.............Lining material...-,........-..-...,..Size: Diameter.....................-.Depth................................. <br /> Cesspool: Distance from nearest well....._..........Distance from foundation....................Lining material......-................-............. <br /> ❑ Size: Diameters ,......Depth-------___........:._...-.........---.... .Liquid Capacity..........................-gals. r' <br /> Privy:. Distance from nearest well.........-------------.........................Distance from nearest building........---_----......................... <br /> ❑ Distance to nearest lot line..........................----.-..-.._--.. ..-_-...._...----.__.._._...................----.-•----.....-...... <br /> 1 <br /> Remodeling and/or repairing (dascrikie):..................._................-._...-..............--------•--....---.-.--'-----..-..---.....-......-'-...._--------------.._....._... <br /> ------... - -- - - ......-.. -S- -............... - -............................ - ---...._. <br /> -.--..,...p,.............. ............. - - -- <br /> ---• •--.._....-- ----..-_..... ------- <br /> _.._.. --- ._.-... - ...... ------------------------_---------------•------------------------------..------------------------------------------...._.............................. <br /> .........................------- ---.............. ------.......................--.-._-•---- . ...........----..... --....................--......................... <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 regulations of the San Joaquin Local Health District. <br /> By:........ ---------------------------------------------- <br /> .._(Title)...._.......__.....- .._.._.. `........- - - - <br /> (Plot plan, sho iii ng size of lot, locatlori of system in relation to wells, buildings,.efe., can be placed an reverse side). <br /> f FOR DEPARTMENT USE ONLY I <br /> APPLICATION ACCEPTED BY..-- -----­­­--- -- - - "-...............:-----------._..--------• DATE..1.'2-..:"1C4tAr_-..._...--...-----....-.... <br /> REVIEWEDBY...........-.................-............................................................................................. DATE........................................................ <br /> BUILDING PERMIT ISSUED.........__- ._:-..-...-_............... -- ------- ----...- -... Di4TE..... --------------- ... - ..._. <br /> Alterations and/or recommendations......... <br /> .......................................-.._. _.....-....... -.... k <br /> ......_................... - ----'- - --- {------------.------------......----------------•---------- <br /> --..-..-."..---- n rig-t :...-.,c ....... x.......................-......_.............._.-_._ ...... <br /> ................ .............. .. <br /> FINAL INSPECTION BY:. - .......... ..._...........` - ....:-- Date.& ... <br /> ��..:`-f............-............................. <br /> -..._..._ <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Harahan Ave, 300 Wett Oak Street ... 144 Sycamore Street 205 West 9th Street <br /> lltxkbn,Calllamia Ladj,Califernie Manteca,California Tracy,California <br /> f.P.Ca. <br />