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( FOR OFFICE USE: <br /> F <br /> ..-•-• -----...._. •••..... -•-••-. . .... <br /> ..__.___.......... . ..........:.... APPLICATION FOR SANITATION PERMIT Permit No. 192 s7 ,� <br /> .........:------- •--------------------- --------- (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Data Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct mall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS A N ... d:. P• .a''` <br /> . .... - r -..._.'.. <br /> ................ <br /> Owners Name......... -----••-- . Phone............................-••-. <br /> -- <br /> Address.................. ......... ......... -------............................ Phone................................Con}rector's Name. ... <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other <br /> Number of living units: .. ..... Number of bedrooms _..----- Number baths......... Lot size ...... -._. <br /> Water Supply: Public system ❑ Community system 0 Private 't Depth to Water Table _...__. ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date................... I No ❑ New Construction: Yes ❑ No ❑ FHA/VA. Yes ❑ No❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well....`:.....Distance from foundation....................Material' ........ <br /> �] No. of compartments..._��.... .._.-'....Size................................Liquid depth......... ... .. ........Capacity....................... <br /> Dispos Field: Distance from n ea rest,we'll. :._---Distance from foundation_..._/,. ..'..._.Distance to nearest lot line...X. <br /> Number of Ilines-.�_'-�`...1-..-�.-- Length of each line...... of trench..Z-I. <br /> Type <br /> •---...-- <br /> T e of filter material...._....._�.-X!._....Depth of filter material..../-�.__.___--..Total length.._f.fly._.'_......................... <br /> Seepa. Pit: Distance to nearest well_.J.4:0ry±r Distance from foundation.__l..............Distance to nearest lot line__.......... �y <br /> . t. <br /> 1 Nmber of pits...------/..........Lining Size: Diameter....... ..._._..Depth... ..i............ q`�t <br /> Cesspool: .Distance from, nearest we <br /> .... __: Distance from foundation_ ................Linin materiah................._....... .._...._._. <br /> .�_- g <br /> �... <br /> ❑ <br /> Size': Diameter. .. .. . ... .......... ....Depth-._- ._..------.--_ ----------------_-_--_-Liquid Capacity..... ..........gals. <br /> r'rivy: Distonce from nearest we1.. ___..........................Distance from nearest building <br /> ❑ Distance to nearest lot'line ..................................._....._._..........__..------.._._._._._._.._.- •--•__---_ I _\f <br /> Remodeling and/or repairing'(describe)______________._..._.� .. `�..•-•-•--- •- ' .•r <br /> ..................................._.._ �--- z-r .• - - ��r - <br /> Op L <br /> ...................... -.............-_........................----......___.............................................................................................._..........._................. <br /> .......... .............:................................................ ....._....... I <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 taws, a rules and regulations of the San Joaquin Local Health District. _ <br /> (Signed)......................... <br /> -......------------- --------------------------------------------- <br /> -- ^ and/or Contractor) <br /> By:.................... ........................... �`--�— <br /> ._ ..---•-••.. .......... .....•.-•--------............... ..._...:..._ ......?--..._ . ..�.....- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> oa FOR DEPARTMENT USE ONLY I 1 <br /> 0011, <br /> APPLICATION ACCEPTED BY.....- .. . .. . .. ----._ DATE.IlV ...- ...!.. <br /> REVIEWEDBY......................................-........-_...._......---......----------.....------------ ---••••----------•----•--- DATE._.....-.._....--.....`_. I <br /> BUILDING <br /> MIT ISSfJED... ................._-............................--_.............................. DATE----- ..........--•--•-= --- I <br /> Alterations and/or recommendations:.........................._....... <br /> _.....--••----......._.........--•---•••......-•......................-•- ..-••-•-•------•-._.........----•---......--•--•---.................•--- I I <br /> f............... -•-•--•--•----- <br /> ••... --..................................• ..-------- ....... <br /> FINAL INSPECTION BY:- // 77 , <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601!.Hasellon Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 91h Street F <br /> Siocktan,California Lodi.California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />