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--------------FOR OFFICE USE: --_...----.- APPLICATION FOR SANITATION PERMIT Permit No. I .......................... .......•.....--••--••---•---• -7..�� '__ _ _ _ (Complete lin Duplicate) Date Issued ......... This Permit Expires 1 Year From Date Issued ._._._ ...�0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her ' escribed. This application is madcom• iance with County Ordinance No. 549. DDRESS LOCATTI�I,ON-••-• •--•---- ........ ......... ......../ �yr.. -P �i sr r:--•-F-•--•--...---- Owner's Na e. �? „�_ .....--_... -•. Ph ................................... _ VI -. . . .... .--_..: Address ra.l.._ ..---� :..T.. o Contractor's Name...... ...._..�. ...... .. ............... ...•••----•----•-_..... Phone.................................ii. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑ i 1' Number of living units: /-._-- Number of bedrooms .J._ Number f baths _�._- Lot size ... .• --. ........ .............. Water Supplyi Public,system El Community system ❑ Private Depth to Water Table .____ ft. r , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam EV Clay❑ Adobe❑ Hardpan❑ Previous-Application Made:\Ilf;yes,date.....'......:........) No ❑ New Construction: Yes ❑ No [] FHA/VA: Yes ❑ No TYPEiOF�INSTALLATION AND SPECIFICATIONS: (No septic tank br,cesspool per6itted if public sewer is available within 200 feet.) Septic Tank: Distance from nea#est well.................Distance from foundation....................Material...-.-.----..__-.--•-_._-_•_---_-_.._...__ ---- ❑ Nro. oficompartments................----------Size............._..................Liquid depth..........................Capacity------ --------------- W Disposal-Field: .—Distance.�from clearest well..................Distance from foundation....................Distance to nearest lot line................. 0)ElNumber of lines.....A...........:.....*..........Length of each line..............................Width of trench..................................... Type of filter material.........................Depth of filter material--__.___._______.....-__Total length.._..._.......:........................... ,,rr�� See/pa '. Pit: Distanceoto nearest well-__/p[J-._...---Distance fr Voundaf ion_._�:'�_._..___.Dis ce to nearest lot line.. ............. P � wi Number of pits_..._'_ 1_.....�__Lining material Size: Diameter._..__. b �� _ Depth . �j ---. -- . v�- ..................0 Cesspool: Distance t1om nearesAwel(.................Distance from foundation....................Lining material material...............__ Liquid Capacity ❑ .......... .....................De th-----...._-..-•---- -. ------ -------- - ..._..___9._.a..l.a_.. Privy: Distance from nearest'well!................................................Distance from nearest building......._............................ -V� _4--s-1Distance;fo„nearest }ot line---_..............................................••---•--.....-----....._..._.._._.__._..._.__._._._....-.-----.-•--••------•-_-..._..__.-...�rr-^t Remodelingand/or<,repairing (describe]:.......................__...................................................•.......--••---.......--•..._.....--.................................. Cj r .. ...f I hereby ce ' y hat'l have prepared this;application ardlhat the work will be done in accordance.with San JoaquiivtCounty ordinances, Sta w , and rules and regulatiti • thosSAn:Joaquin Local Health District, r I: . t Yr J (Signed)__ .. .. .................. :..... ...... _...._._... .... 4 or Contractor) �.. (Title)............................----------------------------------- By, 1._...- t (Plot plan, owing.size of lot, location of syst in relation�Q�911s, uildings, ec., can be placed on reverse side). l � FOR DEPARTMENT USE ONLY } I APPLICATION ACCEPTED BY- :2�rxt.�� ”.?. ........................._. PATE._._ -"'�"``r REVIEWEDBY.....................-.._--.................................-...............................--•--•-•-•---••••-•• .............. DATE--_----------------------------------------•--------•-. BUILDINGPERMIT ISSUED.....................................•'---•----•----- .......–............. j..._.-....._ OATE.................................. •-----_-.-._-_------. Alterationsand/or recommendations:.....................-•--........_--------.-....---._..._....----........).----..._....--I--..._.........._..----•._......_.................................. ...................................•--...f..._....._.....[.....__...-----..._.. .. I 1 ...............•----------......... .............-----.........._..........-•----.........---...I........----------................... ...............;....-•------•------ ............................................ ...FINAL INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maaelton Ave. 300 West Oak Street 124 Sycamore,Street 203 West 9th Street Stacklan,California Lodi,California Manteca,California Tracy,California E9 9 nCVISM0 6.59 3M 3-'63 1r,PX13.