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FOR FF10E USE: N, i <br /> " ---- - ------IM APPLICATION FOR SANITATION PERMIT Permit No. ... ............ .. <br /> ------ - <br /> - . I1 IM (Complete-in Duplicate) Date Issued <br /> ------------ - - <br /> I IM_�_ This Permit Expires 1 Year From Date Issued <br /> Application is hereby mar s <br /> ode to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This a lication is made in compliance with County Ordinanc No. /4 .6, r <br /> 1, <br />' ------------------------- <br /> JOB ADDRESS AND LOCAfION----------- --, -- -r- '--- ----- f� <br /> Owner's Name --- --_� --------------- Phone__`7`. -1�- <br /> ------- ---------------­--.------------------•-------------- <br /> Address `f <br /> ---------------------------------• ai - •- `4- <br /> Contractor's Name- - 1� � J CYC Phone_. <br /> I Motel Other e_,,, <br /> Installation will serve: Re sidence partment House ❑ Commercial ❑ Trailer Court ❑ ❑ ❑ <br /> `Number of bedrooms 4_ Number of baths 7—Lot size __�. -�- -f- -� <br /> Number of living I�'units ._ __ ; <br /> Water Supply: Public systerlk �mmunity system ❑ Private ❑ Depth to Water Table . �ft <br /> Character of soil to a dapth I�olf 3 feet- Sand El Gravel [I Sandy Loam -1Clay Loam E] Clay ❑ Adobe Hardpan ❑ <br /> �� Il - <br /> Previous Application Malde: flf yes,date-_..__..--- 1 No ❑ New Construction: Yes ❑ N FHA/VA: Yes El No ❑ <br /> \n <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r \! <br /> SIM IIE / t r,a! --- V <br /> Septic Tank: Distancellhfrom nearest well -�'kY_Distan e from fon aeon.__[ <br /> No.'of compartmenfS­7--------------------- Liquid depth.v ------ Capacity--�- �- ` <br /> ' Distance to nearest lot line_________________ <br /> bis osal F• Dishnce from nearest we{9.................Distance from foundation__.._____.-.____.._.Dis a <br /> P <br /> J� Number f fines------------------------------ Length of each line_..:----------------------.--Width of trench----------------------------------- <br /> TypeI <br /> of filter material------------------ -----Depth of filter material-----.-----------------Total length_____._.._____.-------------------- <br /> pale i : Dist"ncel�to nearest well_..._..___._----__.._Distance from foundation-------------------.Distance to nearest lot line----------------- <br /> 'a <br /> f pits. Lining material - - Size: Diameter Depth---- ------------------------- <br /> Il ;�� <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- ..Lining material--.._______--_--__-._-__-_-_--.-.-_-. <br /> ❑ • 'I. 'I ! De th -------. Liquid Capacity--------------------------gals. <br /> Size. Diameter- -- ------------ --------------- P _ <br /> I Il �I _--- ___..Distance from nearest building..--.Privy: Distance from nearest well..`........- g - <br /> ❑ Distance to nearest lot line ------------------ - -' t' " = � - <br /> - ---------- <br /> � - <br /> Remodeling anti/or repairing (describe):__-.__... <br /> i ------ - ti <br /> f <br /> IIi --- --- - --- -- <br /> l�. �� ------ --- -- <br /> ----- --- <br /> I hereby certify th�lat I li'ave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St a wand hulys and regulations of th San Joaquin Local alth District. <br /> (Signed) Contractor i <br /> ---_ ----- - <br /> -- - p - ( 1. <br /> �I� - --------------(Title) --- ------ -------- -- -- ------- - <br /> By--------------------- - ---- ---------- <br /> (Plot plan, showing size'f of 104, location of system in re ion to wells, bui71n ', etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY r <br /> APPLICATION ACCEiP TE0 BY----------- ------- ---- --------------- -------------------------------- DATE. ----- <br /> "� ----- <br /> REVIEWED BY----------- `= <br /> DATE------------------------------ ---------------------------� <br /> BUILDING PERMIT 155 - <br /> ISSUED-:------- -• - ------------------------------------------- ------------------- -------------------- DATE <br /> Alterations and/or recommendations------ ----- - -�-- - ------------ -- - --- ---•---------------- -----------------------�------------ ---- -•-------•------------- ------------ :> <br /> :I�. ��� ----'� <br /> ------------------•-- - - ---- - ------- ------- - ------------------------- - ---- <br /> d1dl ------------------------- ------ <br /> ----- ------- <br /> IM -------------- -------- - -------- --- - ---------- ----- - <br /> ----- <br /> FINAL INSPECTION BY DateDate --(- -- --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasollon A,*. 300 West Oak Street 124 Sycamore Street 205 West 9Th Streer <br /> II <br /> Siocklon,California Lodi. California Manteca,California Tracy,Colifornir <br /> E.H.9 2M 1-67 Vanguard Pre s - <br />