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FOR OFFICE USE: .��/ __---_----- _�__3��____ APPLICATION FOR—SANITATION PERMIT Permit No_ __________________ ------ 4�-- ---. (Cot`hplete in Duplicate),._ • • Date Issued'-- --^f v.-..t' ` �__._____.._----------- --- ------ This Permit Expires. 1 Year From Date Issued 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 AND LOCATION______ __________ Owner's Name----------�-t------- 'R--------� - ----- ------------------------------------------------------------------- Phon�'K_�_�_� � Address �' 1�✓�_-� / ...--- ------------- ------- �r f --------I—--------------------------------------- Contractor's Name_-•-< f : — �"C�� C !t.t�� !L Phone.-_--------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ ailer Court ❑ Motel ❑ Other ❑ Number of�Hv units: _Number of bedrooms __--__-_ Number of baths _ `Lot size ____- j ____ a- -� Water Supply: Public system ❑ Community system-❑ Private [Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ©flay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,date--------------------) No g-"New Construction: Yes FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / y----t1-tom Septic Tank: distance from nearest well_ n-----Distance from foundation__._,_(__.._.Material - __________________________ i t l-�] J3C�� ✓ [ � No. of compartments------------7�'.....Size_, '(___ .�'� ___Liquid depth---- - i----Capacity._.. _�_.___r_l� Disposal Field: Distance from nearest well__-d._Distgnce from foundation. i'S�...... __ .Distance to nearest lot line__�?:f.... Number of lines_______________ / -Len th of each line___._____` -P_-_____._.Width of french_____� ---------------------- Type l,__ .___.__.___"._.__ r Type of fitter material__-_ � /Depth of fslter material___,____ ____._Total length------- :_. __---------------------- Seepage Pit: Distance to nearest well______e_t"Vf---Distance from foundation__ __l_ f_.___.Distanc,�a to nearest lot line _f__ _._ Number of pits----_--_/- `f _________Lining material___1 0_,4C/Size: Diameter.___�S_?..__..___Depth------- - ---------------- Cesspool: Distance from nearest 'Well-----------------Distance from foundation---------------------Lining material--------------------------=_:________- ❑ Size: Diameter------------- ;'�=.:Depth---------- '--------------------------- Liquid Capacity----------------------------gals. ❑ --------------------------------------Distance from nearest building------------------------------------------ Privy: . Distance from nearest well-------------••-----•---------------------=----•--------:------------•-------------------------------------------------•------------------- Distance to nearest lot line__.___._ 4 Remodeling and/or, repairing (describe)_____________________________________ - ---------=-=----------• ---------------------------------------------------------------------------------------------------------------------- -------------I---------------------------------------------------- G ��'.-`-: , ---------------------------------------------------------------------------------- ----------= ----------- = ---------------- ----------------------------------------•-----------------------------`----------•- ::------------------------------------------------------------------------------------------------- ------- S�+ 1 hereby certify that ave prepared this application and that the work will be.done in accordance with San Joaquin County ordinances, State laws . rid IesZaregulations of the San Joaquin Local Health District. .12C _. � -----------------------------•--------------------- ----------------------------(Owner and/ (Signed) or Contractor)' By:----------------------------------------------------------------------------- ------------------------------------------------------(Title)-------...."----------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- --------------------------------------- DATE--- f�--------- ---------------- -- REVIEWEDBY---------------------------------------------- ------- ----------------- ------------------------- DATE------------ ------------ ----- Alterations and/or recommendations ---- `� -- _-- ------------•---------- -- --===-- bATE--------------- +------------=------ _----------------- BUILDING PERMIT ISSUED_____________ ____________________________ •�------ - ---------- ��--�`-_---------=��`----— ---------r'e'.-e` c�-* �-` -= '—------- -----f� GY"f�------------------------------------ ----------------------------------- -------------------------------- -----------•----------------------------- ---- --------------- -------------------- ------------;--------------------------------------- ------------ - ---------------------- - ----------------------------------------------- •------------------ FINAL INSPECTION BY:--- Date_-------- ;L. � :/ -- ------------ - --- A, � N J QUIN LOCAL HEALTH DISTRICT , 1601 E.Hazelton Ave. 300 West Oak Street X124 Sycamore Street 205 West 9th Street Slockton,California Lodi,California r Manteca,California Tracy,California �I ES 9 REVISED 8-59 3M 3-'63 F.P.CO. 4�