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FOR OFFICE USE. ----------------------- ------- --------- k � L c d APPLICATION FOR SANITATION PERMIT Permit No. ...,1 ------------ -------------------------------------- Complete in Duplicate) Date Issued _.��-.. ?/ -------------------- ----------------------____.__-_.... This Permit Expires 1 Year From Date Issued 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. ° i JOB ADDRESS AND LOCATIO ------••--•---------•-•---------------•---------------------•------ g..r Owner's Name , - --- •---• •--------•-- Phone------------------------------------ Owner's •.•.`-•�--------••�••------------•--------------------.......•...............................................= =-----_--------------- ....--.---•........................... : Contractor's Name---------------- . 'AO�.�-----------•---------,—---- -----•--------- Phone Installation will serve: Residence Apartment House ❑ Commercial`❑ Trailer Court Q Motel ❑ Other ❑ Number of living units: _'.._ Number of bedrooms . -- Number of baths _ :... Lot size ._ eh.1 _� ' ---------------------•--•••-•••- Water Supply: Publicsystem [Community system ❑ Prate E] Depth to Water.,Table_� it. Character of soil to a depth of 3 feet: Sand E] Gravel 4�_sandy-Loi-a—mEj_61a ,Loam ❑ Clay ❑ Adobe 2k"Hardpan ❑ Previous Application Made: (If yes,dcite ---- "'�) No gEr New Construction: Yes C] No gal" FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 p (No septic tank or cesspool permitted if public sewer is available within,200=feet.) � /r .f I Se tic Tank- Distance from nearest ell__`��__..Distance f om foundation...__fe�_______.1� ferial___e.... -� ................... ¢ No. of compartments----_P_---!-------Size-_,3-y---------•-------,Liquid del?th__._ t�'-- -----------Capacity-- a r.•-•_-- i Dirpo4s, ,'eil Distance from nearest well._-.__r__, :_.-Distance from foundation_ f�.........Dista nce to nearest�lo� line.... Number of lines------f-------�_- -- I- Length of each line------ , Vis_----_.Width.,of trench.- Num. of filter material,`l,2/�� Depth of filter material.[1 --________Total length..____'�c _`._.___. Seepage Pit: Distance to nearest well------ '.___-----Dista �jr tion�;!Ae.__._...Dop 4V istanct3 to. nearest`lof line.. . Number of pl�s._____�_____________Lining mat rial_ k .: f�-% Depth__ !-_-- ize: Diameter__- \ Cesspool: Distance from nearest well---------_.......Dis ce from dation------ ------fLining materia . __ _� _._____....____.__..... [) Size: Diameter.__.-------- •---------- ' _ i'>�'- Li uid Ca aci._'--:-----`-- - gals* Depth = --- p - - - - i q p ,., . .,� s Privy. Distance from nearest:we'll______________ -- --------------------------Distance from near build ng_�__. _______:�___---____-.- Distance to nearest lot line--------------------------------------------l --------=- , '�--•------------------------- -------------------------------- n c h Remodeling nd/or pairing (d tribe):-- y'_ J�// -- --... f >� ----------------------- ; --•--------•- - •------- -- -- ---------{----------•------------- ------------•-------I -------•••----....------------- ----------•----•---------•-----•- ------ ------------------------------------ ...... ---------------------------------------- I ---------=----------------------•----- ...._.. Ihereby certify that I have prepared his applications and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the'San Joaquin Local Health District. . 7 ' ( -;.Contractor) -(Signed)----_-----•--••----- Title---... :--.------------ ------------- By--------------------------------------------------- ----------- { (Plot plan, showing size of lot, location of system i r �ion o wells, building s;etc.;can'V -placed-on`reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---------- -----------•----------•----- DATE---- - -_1 -- -- •-------------•------ REVIEWEDBY--------------------------- ----------------- DATE•----------•--------•---.---------------------•------------ I. BUILDING PERMIT ISSUED---------------------------------------------- --------------------------------- ---- DATE------------------------------------------------------------- Alterations and or recommend' tions:__ {------------------------• - -----•• - - - �. �_ - ------ i ---- -- - � --.. ----- ------ ••----------•------------------ ------------------------- --•----••--------•-- --------------•- ----------.-------------------•-- --------------------------------------- ------------------------------------ -•-------•--------------------- FINAL INSPECTION BY: •----- -- ---- ----- ------ Date.... -----1-Q_ -`r (Q------------------------------------------ SAN JOAQUIN LOCAL HEALTH-:DISTRICT 130 South American..5tmet 300 Wed Oak'Srriet 124' Str1° 205 West 9th Street 5loiiclon,Ca'lifornid-`*^ Lodi,eallfornla Manteca,California Traey,.California ES 9 REVISED 6.99 8M 3-8° ATLAS