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FOR OFFICE USE: ------------- ------------------------------------------- Permit No. APPLICATION FOR SANITATION PERMI �� ------ ----------------- -------------------------- (Complete in Duplicate Date Issued ---------------------- ---� -�----- -�---- ---- -- ---- -- ------- ----- This Permit Expires 1 Year From Date Issued d. A lication is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein describe This application is made in compliance with County Ordinance No. 549. ' -�--•------•----------- -------------------•------------------------ JOB DDRESS AND LOCA�T�I�OrN__r_, �/ .-71----------- Phone------------------------------------- Owner's -----------------------------•----- 01*1 Owner s Name----- --- -----•-------------------- ----------- Address------------ ----- �J ---------------- " � /G,D� � Phone Contractor's Name_____ ___. - - ------- - ------------------------------------------------------ --�-��'------- - - -- -- - -- -- - - - Other - Installation will serve: Residence !Apartment House ElCommercial [I Trailer Court ❑ Motel [I Other Number of living units: _/--- Number of bedrooms ._ _._ Number of baths Lot size _A0_6'W_0"-----------------------------------� Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table � ft. ~man Character of soil to a depth of 3 fee : Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Application Made: (If yes!�late -1�- .= ) No ❑ New Construction: YesNo ❑ FHA/VA: Yes R�*No ❑ Previous App i TYPE OF INSTALLATION AND SPECIFICATIONS: „, _ a , (No septic tank.or cesspool permitted if public lwer.is available within 200 feet.) ��------Merial__ s�s��' --'------ Septic Tank: Distance from nearest well_- IDistanc/from.f,�o/undation__f __ / .;� Ca acct X'4V41 ____-- '' No. of compartments_. ----.,J------- „ iziD-�•_ 1n_- :---Liquid,depth ---- P Y Disposal Field: Distance from nearest well'-6 ----"Distance'-f%m ifoundat' n__�_ -„-r - -----Distance to nearest lot line --�- Length of each 4ine__. ------------------ -Width of trent ST'S-------------------------- Type .----------------------- - Number of lines_-___ -- ------ .ds � ��`` Total length-- rf = F Type of filter material-/ Depth of filter materlaL}_% -_-...__- 9 p9� +. Seepage Pit: Distance to nearest well__Z/a----_.____Distance fr fou dation___ _- Distance to neor ares{-p-�e .Size: Diameter- _ Depth Number of#pits----/--------�----Lining material-- _-� - � �.. �. ing Cesspool: Distance from nearest well_______________-Distance from foundation----- ------ ¢-°Liquid Capacity_...___._-________ -------gals. ❑ Size: t?iameter.. -------- -�-------------------- -------------------------------------------- � -. 1: Privy: Distance from nearest well---------------------------------- __..-Distance from nearest building.--!----------------------------- 1 f�------------- --------------------- ------------- ❑ Distance f' ,nearest lot line.. � /! --------------- Remodeling and/or repairing (describe):____�r .p�1�- ��' ------- �' ---- �-�----- --- ---------------------------------------------=-------- 1 - - ---------------------------- -- ,,.�I Hereby certify that I have prepared this application and that the work will be done in accordance with San,Jaaqum County I :-ordinances, State laws, and rules arid;regulations of the San Joaquin Local Health District. _ _J I -” --_ ((IM +�r Contractor - ---- ------ ---------- ----------- �_. -� (Titl { + .�� 3 By:------------------------------------------- ---------------------------------- -------------- (Plot plan, showing size of lot, location of system in rel i #o wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY ; 1 1 DATE-- - �� . APPLICATION ACCEPTED ABY_----- ----------- DATE------7' r 1 REVIEWEDBY------------------------- ----------- ------- -------------------- ------------- BUILDING ----------- ----=------------------ �_ - ---------------------- DATE----------------------------------------------------------- BU I LDI NG PERMIT ISSUED----��•--------------------:. -; , Alterations and/or recommendations:_-____.. �-'----- �----- ------------------------------ ------------------- ------- ---------------------------- 1 ` - --------- ----------------------- --- -------- - FINAL INSPECTION BY:------ -- Date--------�._' � -- __ ---.'- ---�-- -- � - -- ----- -�- SAN JOAQUIN LOCAL HEALTH DISTRICT sr300 West Oak Street 124 Sycamore Sfreet 205 West 9th Street 1601 E.'Ha=ellon Ave. „ . E Manteca,California 1yTyr�acy,California Stockton,California + s :Lodi,California S x F.P.CC.