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FOR OFFICE USE: --------------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. ,1..�__-/ . ------------- ------------- -- -------------------------- (Complete in Duplicate) Date Issued ------------------ ------------------------------- This Permit Expires 1.Year From Date Issued .._. _--�----b---- 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. JOB ADDRESS AN O TION.ly� a I Owner's-Name - ----- -------- ---•--•----------------------------------------------------------- ---------------------- Phone------------------------------------ R Address------------------ .-•2-----k-- Contractor's Name------ - --•------- -------- -- -------- --------- •-- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units._- Nurriibe`r of bedrooms _o?- Number of baths -c2-- Lot size - Qd------------------- ------- ------------------ Water .Supply: Public system ❑ Commun'ity'�,system ❑ Private�J' Depth to Water Table 4-o ft. Character of soil to a depth of 3 fee+: Sand ❑?. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jff Hardpan ❑ Previous Application Made: (If yes,date---------4------ -) No X New Construction: Yes ❑ No�i `t FMA/VA: Yes ❑ No ❑ a-TYPE OF INSTACLATION AND SPECIFICATIONS:; (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) e' • Tarlk: Distance from nearest v;ell---_----:.___ Distance from foundation-------------------.Material----.----__-____- yNo of compartments-- --------- `----..-Size---------------------------------Liquid depth------------------------.-Capacity----------------------- Disposal iel& Distance from nearesl well,..........Distance from foundation-3-Q----.....Distance to nearest lot line- ------- ®® Number of lines------ ------------ -----' Lengthof each -_.-.Width of trench--- _ --------.-----� "# Type of filter material-- r.- -Depth,.4 filter material-----Aff- ---_--.Total length_-___-_____--:--__-- Q0------ Seepage Pit: Distance to nearest well_---------------------Distance from foundation------------------- Distance to nearest lot line-------------- [� Number of pits----------------------Lining material = _ Size: Diameter Depth Cesspool: Distance from nearest well-----------------Distance from foundation___.---------r-___.Lining material--.-----__-_-.__--------..--------- M r Size: Diameter--------------------- -r-------------Dept ----------------- --------------- --------#-------Liquid Capacity gals. Privy: ..-. ..�,>.,,.. Distance from nearest building Distance tom Barest'well = 9 Priv❑ Distance from n� '` rest lot line---.---- - " 2 , +r�L . Remodeling and/or repairing (describe):-__ L 11 r -- . ----------------------------------------------------------------------------------------------------------- - �. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County', ordinances, tate laws, and rule and eguI tions of + San Joaquin Local Health District. {Signed) - ---- ---- - ------------ ' -' (Owner and/or Contractor) . ------- I Title BY=------------------------------------------ --- (Plot plan, showing size of lot, locati�nn of systAmiin relation #o w , buildings, etc., can be placed on, everse side). FOR DEPARTMENT,USE ONLY APPLICATION ACCEPTED BY DATE-------s 7/--1�---3-------------------- REVIEWEDBY------------------------------------ - ---- --•-------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------- ------------------------------ -------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------------------------------- ------------- "-------------------------------------------------------------------------- ----------------- 1 f c ------------------------------------- -----------------------:_111---------------------------------------------------------- ........... -- •-------------------------------------------------------- ----------- - ------- ---- ---- - ------ -------------------------------•----- ---- ------ -------------------•-----------------_-------------•---------------------------------------------------------------- FINAL INSPECTION BY: Date 'l ;West JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 30 Oak Street 124 Sycamore Street 205 West 9th Street 5tacklon,Californla Lodi,California Manteca,California Tracy,California 1. F.P.E O. [