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FOR OFFICE USE: --------------------- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ] p ) Date Issued -- � ----- -------------- ----------------- - --_-_-"__-" -.................. � This Permit Expires 1 Year From Date Issued - ___ ____ --- ----- ------------ - A licatio pp n 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 AND LOCATION- -- --- -- '��'"�=`-'--�- r ........------------------ Owner's --- - ------- ---- --- -----�- Phone------------------------------------ -- Owner's Name-----_ __ --�-- • .. _.: =-- ----------------- Addres �s -- ---- ... t...._ Phone----------------------------------- Contractor's --------------------------------- 1 � Contractor s Na e_. _ •---"-------"" --- •"" - - � Other Commercial S I Trailer GGw4 > Motel ❑ Installation will serve: Residence F! Apartment House ❑ ❑ .. Lot size 4 4$7L_------------ ---- Number of loving units: _�.__-_ Number of bedrooms _" --._ Number of baths " Water Supply: Public system ❑ ;.Community system ❑ Private Depth to Water enabled ft❑ Adobe❑ Hardpan Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa ,�] Y ! : (If date_-- _--------. 1 No ❑ New Construction: Yes El No E] FHA/VA: Yes E] No El Prevlous A pplication Madeyes, .-_.- # TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] tic Tank: Distance from nearest well-_I�-.-6__-.__Distanc from foundation__. .n--.-------Material _ �------- Sep �` _�' Li uid de th--- - ------ ---- CapacitY �. ''-U No. of.compartments____,�---- ----- -Size_:--- --"-- - q p i I tea Distance from foundation__-Q-.-------Distance to nearest lot line_ -..-- Disposal Field: Distance from nearest well_�_..h-. --- Width of trench..- l----------------------- Number of line's ...... Length of each line-- "al��---- -------- - a Type of filter materiald- --------Depth of filter matenal._. ""--.-------Total length._- ----------------------------- Type ------• A -- I I O Seepage Pit: Distance to nearest well._�6.b-.--------Distance from foundS�ze n metef._ p'S ice to Depthsfi --- ------ ---- Number of pits___ --------------Lining material - � Cesspool: Distance fromf nearest well ----- - ------- hep+hce from foundation---------------- -L`quid material Capacity... _ --------.------------gals. ❑ Size: Diameter- -_ _ Privy: Distance fromdnearest well------------------- ------ -• -----------_.._-__Distance from nearest building_________________________________________ ❑ ----- ---------------------- istance to nearest lot ine -------------------- - ' ---------- ------------------- •------ ----------------- n and/or Drepairiing (describe)------------------------- ----------------- Remodeh g P ---_-_-_--. _____________-_____-._________.__..__ --------------------- ----------------------------------------- t =" -- -•--•-------------------------------------------------- k I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules a nd r gulations of he San Joaquin Local Health District. s (Owner and/or on ------ -- -•- tract (Signed). -- ----------- -------------- _ - 4 - ---- ,. : �� -� = Title "-T- -----�----- :_---- - --------- - - : (Plot plan, showing size of lot, location of system in relation to wells, build'+ngs, etc., can be placed on reverse slde]. FOR DEPARTMENT USE ONLY ---------------------------------- - - ---- --------------------------- --- -- i APPLICATION ACCEPTED BY DATE-_DATE- ----- ----- ---•--------- REVIEWED BY----- ------- --------------------------- -------- --------------- --------- DATE I ------ BUILDING PERMIT ISSUED-------- ----------------------------------------- I Alterations and/or recommendations ----------- ------- --- ------------------------------------------- Alterations -- ------- --- ----- - - -------- - ----- - '° -------------------------------- - - I! This 5 Stem Dan -- 'rte note on otvnerf s co Y W Y - -- --- --------------- - - --- - ..'.. - -----• -... - - �nat 'fie a roved *or F H.A. or V.A. ----------------------------------------- tbecause it was no completely ans ecf:eel. Date-. ..---_- '---------- -w----- ---------------------- PINAL INSPECTION BY:------ `-• " . ----- -- ------ - ---- ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Ha:ellen Ave. 300 West Oak Street 124 Sycamore Street 20.5 west 9th street Lodi. California Manteca,California Tracy,California Stockton,California E.H.9 2M 1-67 vanguard Press S -