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FOR OFFICE USE: <br />Y­ <br />--------- ......j <br />.. ...... APPLICATION FOR SANITATION PERMIT Permit No . ... . ....... <br />..................................•--..................... 4 (Complete In Duplicate) . -- C <br />/../..____ _3 <br />................ ..................... ............ This Permit Exaires I Year From Date Issued Date'Issued --- <br />-tion i hereby' made to the S" <br />Application I an Joaquin Local Health District for a permit to construct and install thii work herein described. <br />This applicatiln,!§ <br />_�acle I' , it County Ordinance No. 549. <br />comp ion" y Coul <br />JOB ADDRESS AIOC <br />Nome. Owners N ....... 00� ...... Z.1 ............ .............................................. Phone............. ................... ... <br />7 <br />Address ................../A.4 ....--•------•-•-- - ............................ <br />Contractor's Name ........ �s ........ ------- ------------- .............................. .... ........... Phone.._._....` � .................. <br />Installation will serve: zResidence g<_Apartment House [:] Commercial [] Trailer Court C] Motel C] Other [3 <br />Number of living units; J.... Number of bedrooms _4 --- Number of baths Lot �size'_.I­ 40 <br />%-( ................. ­ -­---------------- <br />Water Supply: Public sysfam.C3 Community system El Private �tepth to Water Table 1.!? ff. L <br />Character of soil to a depth of 3 feet:! Sand E] Gravel E] Sandy Loom E] Clay Loam ❑ Clay E] Adobe ET—gardpan ❑ <br />Previous Application Made: (if yes, dote...:-...__,.......1 No Now Construction: Yes R3'7'No El FHA/VA: Yes D No PR' <br />TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: Distance from nearest well ... if.P.I 4--� <br />,_131-istance from f6undation../A ......... .-.material .... <br />No. of compartments-- ..A� .............. siz*e..��._vf_ -7 Liquid depth....'............:..... .. Capacity-.. 4�OV-6X4 <br />Disposal Field: Distance from nearest well..%570 ........ Dstance from, founclation.1A .............Distance to nearest lot line A?" ... <br />Nu*mber of lines. ..........Length of each line_.. Width of trench--4.1 . ............ <br />"r <br />Type of filter mate C Depth of filter material/$-y--------------Total length ... 1Y 4 ............... I ............. <br />Seepage Pit: Distance to neartist'well._/Af .............. Distance from. f6undation/&..,-.-......Qistance to nearest lot line_ . ........ <br />g a ..-7-,Z� �. ............... <br />Number of pits.-j.3 ............. Lininmateria __._.-Size: Diameter..-5........... Depth <br />Cesspool: Distance from nearest well_-_-_-..-_--- Distance from foundation Lining material--------------------- . ............... <br />EJ Size: Diameter... F........._ .------ ­ . ....... Depth ..... ...................... . ....................... Liquid Capacity ............. ___ ---- gals' <br />Privy: Distance from nearest well .. .................... ........... ......... Distance from nearest building-. . ........... . ...............❑ .......... <br />Distance to nearest lot line ............................................. .. ....................... . ............. .......... ................................ 77 <br />Remodeling and/or repairing (describe): .......................... . .......................................................................................................... . ........... ...... <br />.......... . ... ................................... . ................ . ... . ............................. ........................................................................... : ........................................ <br />.............. ........................ ......... . ............... ..................................................................................................................... .................................... <br />.............. . ................................... ......... _ .................................................................. . .............. ; ........ : ......................... . . ................ ............ <br />I hereby certify that I have prepared this applicati andd,4hat thi,;tork will be done in accordance with San Joaquin County A <br />' T'o <br />ordinances. State laws, and rules and regulation oft San oaquin ocal Health District. <br />(Signed) ...... - - ---------------------------------------- I ....... ---------------------------------- ------- - ------- --- _(Owner and/or Contractor) <br />By: -------------- ............................. I <br />.. .... .. .. ... ................ ........ ........................ (Title) ...... ........ ....... .................................. <br />I. - Ik <br />(Plot plan, showing size of lot, location of system In re ation to w lis, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED <br />BY.4 ...... .DATE_ . <br />................... <br />REVIEWED BY.....................................___.......... ........................................... <br />DATE.........................---•--...................._._... <br />............................ * ............ <br />.. <br />BUILDING PERMIT ISSUED .................................................. . ......... — ...... : .................. ; ........... DATE ....._­ <br />------- ...... ......................... <br />Alterations and/or r d t' i: ........ . . ... ­�_-._. <br />ecomm4�n a lom .. ..... . ..... <br />.......... ........... ... <br />............................................................. I ............ 7 ................... ...... <br />. . . .. <br />.......... ......................................................... .......... ....... ; ------------------------------------------------------------------------------ -------------------------_-------.--_......1_ <br />.................................... .......................... ....................................................................................................... ......................... ........... ... .. <br />............. ....................................................... ............................................................ ....... ..................................... ............................ <br />/-� <br />FINAL INSPECTION BY:- AV . ..... j -- ---- 6 - 2-7 ........................... Date_ ................. .............................. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Maxieltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br />Stiscliftis, Callfwnla Lodi, California Manteca, California Tracy, California <br />Est 9 REVISED 9-69 SIM 3`93 F.P.Ca. <br />/I <br />