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FOR OFFICE USE: ------------------------ --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------ (Complete in Duplicate),_ Date Issued -ZPISI;, -&-�1 - --------- - - ---------------------------- ---------- . 1; - , '. — This Permit Expires.1 Year From Date lss6ed OL-5-r'-70-3 1. —----------------------------------------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 4 This application is made in compliance with County Ordinance No. 549. uj- L-4-0s" 40 e JOB ADDRESS n LOCATION- 2*-4--- -- ------- Owner's Name-- ----- ------- ------ -- ------------ - ----- - Phone --------;-------------- a- ---- -------- J/------------- ------------- -- -------- -- -- -------- ----------- ----------------- ... ..... Phone---------------------- Contractor's Name------ Installation will serve: ResidenceApartment House Commercial E] Trailer Court E] Motel [-] Other ❑ corns S_ -f baths ---?��t size --------- ------------- ------ Number of living units: ---t- Number of be Num[Depth 11 Water Table -------- ft. Water Supply: Public system E] Community system El PriN Character of soil to a depth of 3 feet: Sand I-] Gravel E]I Sandy Loam jClay Loam El Clay E] Adobe E] Hardpan [3 1 4 Previous Application Made: (if yes,clate-----------:--------) No M' New Construction Yes El No El rHA/VA: Yes [] No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic tank or cesspool permitted if public s6wer !available thin 200 feet.) W , 1 40,) - qjcj��ronyfoundation_..__&------Material--- Distance from nearest well------1;P----Dista Septic nk ee,4-, Liquid dep�h------ -_-----_----Capacity.. CZ No. of compartr4nts_ Ae, ----Distance from fourQ 'riclation------ .. ......Distance to nearest lot D;sposa)4ie1cI: Distance from nearest well._j -,dfh of trench -;I--- ---- -------------- Length lof,each line----- W Number of lines...........'Ll_- 'W'. I :e Ir -----Total length------- ---------------- Type of filter rrAterialm-0 , -of 1 -Qter_maferial--------/71 Seepage Pit: Distance to nee fest well______________________Distance from foundation-------------_----Distance to nearest lot line_________.__.__-_ � Numberecrf pits__:';--.- J----------Lininmaterial-------- ---------1...&ze: Diameter-----------------------Depth-------------------------------- -om near s ----------:_Distani clation------------------- f well__-.-------:_Distance I -';e�li'from foin I Lining material_________._.____.,_______.._-______... Cesspo Distance fi _j: I . ...........Depth_) -----------------------------Liquid Capacity...-------------------------gals❑ .Diameter- :---------- 0 -------------i -------- - Privy-. Distance from n1�ar1st_weII___J------------------------- nce from nearest building----------------------------------------- sf a Q..q ---------- ------ s&o-4in—,_J_------------------------t. ----------- ----- --------------------------------------- -------------- ❑ Distance to near. - ---------_-FAA1_1 ----------- Remodeling and/or repairing (describe), -------------------- -------------------------------------------------------------------------- ------------------------------------------------------------ _1--------------------------------------------- - -------------------------------------------------- -------------------------- - ------- ----------- V ---------------------------------------- -------------------------------- ----------------------------------- ------------------------------------------------------------ ------ -------------- ------------------------ 1�_ ----- -------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- --------------------------------------- I hereby certify that I have p' ared this application and that the work will be done in accordance with San Joaquin County ordinances, St S, and rules 01� regulations of the San Joaquin Local Health District. nd/or Contractor) - - ------------------------------------------------------------------------ (Signe -- --- -- ----------------(Title)------------------------------- ---------- -- -----B ------ --- - ------ w, ,Wn well ildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in relation to STU I FOR DEPARTMENT USE ONLY "i .;", _1.,e - --------------------------------- I------ DAT'E---,/ - - ------------------------------------------------- APPLICATION ACCEPTED BY--- REVIEWEDBY----------------------------------:.-------------- ------------------ DATE---------------------------------------------------------- I---- ------------------------------- ---------------------------- BUILDING PERMIT ISSUED------------------------------------------------------ a:------------------------------------ . DATE- -- .1 - -------------------------------- --------------- -------------_---------------------------------------------- Alterations and/or recommendations:---------------------_ -------------L--- ------ A ------------------------------------------------------------------------ --------------------------------------------------------I---------------- -------------- -----------------------------------•--------------( '11171 - ----------------- ------ ------------------------- -------- ---------------------- ------------------------------- ---------- ------------------------------------------------ - ---------------------------------------------------------- ---- ------------ ------------------------------------------I---------------------------- ------------------------ ----------- ------------------------- -------------------------------------------------------------------:---------------- ------------------------------------------- ---------------: ---- ---- - ---------------------------------------------- FINAL INSPECTION BY:_/,A4, - eex--------- --- Date- - w N SAN ateSAN JOAQUIN LOCAL HEALTH DISTRICT i 601 E.Hateltan Ave. 300 West Oak Street 124 Sycarnorltr> 205 West Stir Street I Lodi,California Manteca,California Tracy,California Stockton,California`#Ti Es; 9 REVisro 8-59 3M 3-163 F.P.00.