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FOR OFFICE USE; ------------- 3)" '- - 6- !� �Q! APPLICATION FOR SANITATION PERMIT Permit No. _C2................ ----------------------------------------------------- (Complete .in Duplicate) ` .11 3 _.. This Permit Expires 7 Year From Date Issued Date Issued .✓�-=c .:<r' l: 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. 1.JOB ADDRESS AND LOCAON--' ---- ---------------•--------------------------------------------------- I r -------------------------------- Owne'r's Namer.� --- a--------------------------- Address-- ----•-•--- ------ -- •-••--- -•------------------------------------------------------------- --------•---------•------•-=-------•------------------------------- i _ Contractor's Name----- gX. -------------=-------------=---------•----•---------------------- ---•-•------------- Phone.--••-------•-•--------- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ _ F Number of living units: _f___ Number of bedrooms ,�_-- Number of baths ..1.--. Lot size_ _1Q1. --------------------------------- { Water Supply: Public system [,Community system ❑ Private E] Depth to Water Table Zr9 ft. ' s lCharaicter of soil!t-o a depth of 3 feet:. Sand E] Gravel ❑- Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan .rs Previous Application Made: (if yes,date--------- - ------I No New Construction: Yes E] No R4-`FHA/VA: Yes ❑ No x TYPE OF INSTALLATION AND SPECIFICATIONS: =(No septic tank orcesspool permitted if public sewer is available within 200 feet.) Se_pticcTank: ! Distance from nearest well-----------------Distance from foundation-- .-_-.------.-.Material------------------------------------------------- 'No. --.._---_.-.----------_------------.--------- 'No. of compartments---------------------------Size---------------------------------Liquid dePth------------....- ---------Capacity----------------------- Di!posal A N ld; Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line----------------- .A_�El'f��l'l Number of lines------------------------------------Length of each line-----------------------------Width of trench-------------.------- ----------- Type of:filter material-------------------------Depth.of filter material---------------------.-Total length---------------------•-------------------- Seepage Pit: Distance to nearest well......-- ...__Distance fr m foundation___. .- .-. an to nearest lot line..--..-------- Number of pits----/..............Lining material-. �_Size: Diameter.—-------------DepthA0.1'.. .�..tA� Cesspool: Distance from nearest.well-----------------Distance from foundation---------------------Lining material--.-------------.--------------_----- ❑ Size: Diameter.—---------------------------------Depth--------------- -=----------------------------------Liquid Capacity------------------------....gals, Privy- -.. ' Distance-from nearest well......................................._......_Distance .from nearest building-------------------------------------- ❑ T: r Distance.to nearest,lot Iine------------------------------ ---- --------------------------•--•---•---------------------------- -- -------------------- ------- 9 / repairing 7 f � , �/ - � ' ------------ Remodelin and;or re airin describe :__� _. � ___. Q-� f' ------- ---------------- ----- ---- ---- a ---------------- -- � � � - ' - r . . / ,� r ------------------------ --------------- ---- --------- ----------------------- -------------------- 1 hereby certify at I have prepared this application 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. :f I (Signed) Ii 11!7for Contractor ------------- . 7 By:-----------=i1---•--....--•--------------------------------------------- - ------------=---------{Title)-- - ----- ----------------- -- + (Plot plan, showing size of lot, location of system elation to wells, buildings,.etc., can be placed on reverse side).. il: Ifs FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- Gv------------------------------------------------------------------ DATE--------3 if��------------------------------- REVIEWEDBY---(11---------------------------------------- -------------------- -------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------- -------------`-------------------- --••------------- --------- DATE --------- -------- &I .....:v ------.-, .2-P------.-.Alterbtions and/or ecommendations: . y M Ii ----------------------------------------------------------------- :-- ------------------------ --�------------- --- ------ ------------------------------------------------------------------------- _. ._.. / n FINAL INSPECTION BY------------- ------ --------- - -- ------------------------ --- --- Date---- -------- -� -1--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1L01 E. lazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street StocktalCalifornia 11 Lodi,California Manteca,Callfornk; I r Tracy,California IM, FS 9 REVISED 0.5iII9 314 3-'43 F•P.00, -