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FOR OFFICE USE:
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<br />............. .................... APPLICATION FOR SANITATION PERMIT Permit No. .... . .
<br />...... _...................; JCompplete in Duplicate) }/
<br />_............. ibis Permit Expires t Year From bate~ Issued Date Issued .. ..�?..
<br />005— 114S-3-1
<br />r,r.rAcation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describer}.
<br />This application is made in cornpliance with County Ordinance No. 549.,
<br />JOB ADDRESS A OCATION...��
<br />Owner's Nam¢?- �`` `' _. �........... ......... *::..._-._...._._._..
<br />_.. _...... one,, e
<br />I'll
<br />Address ..... ? �* �'.._� .fJ _. � �" . ? t '` '= ......
<br />w ,,
<br />*vontrtsctor's Name... ... . _............... ir-r ...-.-.�?�-..... _.��'. zrx- ?hone.................................
<br />Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court . - Motel Other
<br />Number of living units:... _. Number of bedrooms .��%, Number f baths .I... Lot°size .__.---,1•�-- �"� ��:..................
<br />Water Supply: Public system ❑ Community system', Private 'Depth To Water Table -...- ft.
<br />Character of soil to a depth of 3 feet: Sand Q-l"Gravel ❑ Sandy Loam [j .Clay Loam Clay ❑ Adobe Hardpan ❑_ ..�
<br />Previous Application Made: Ilf yes,date_.✓..._.-.....--.j • No ❑ New Construction: Yes ❑ No ❑ FHA/VX Yes ❑ No 0
<br />TYPE OF INSTALLATION AND SPECIFICATIONS, ,J ,•'r ..w
<br />(No Septic tank or cesspool permitted if public sewer is avaiiabie within 700 feet.) K
<br />,• i
<br />Septic Tank: Distance rom nearest well: ....._...--_--Distance from foundation ............... ...Material................. .... .......
<br />..........m» _..
<br />❑ No°of compo,"tments....... .............,,.,> Sizes ''�--.--.-------- Liquid depth_ .... ........ ____ Capacity_ ............
<br />..._,._..
<br />Dispos Field: Distance from nearest weI!:�.:� t DisteryC6'from foundation.._ ° 4 ....
<br />� � � �' Distance to nearest lot I � e.._.....
<br />Number of lines.-, ...... Length of each,Iine_.__. .-.--_.....Width of trench...._..'...........
<br />Type of filter material.... (15 7�.Depth of filter ma#aria9. ��� .iotal length.-. ---..... ......_..
<br />See/411
<br />Pit: Distance to nearestewell .Q '._..._.Distance from foundation ..1h.Z..Distance to nearest lo# Number ofdits.._...... ...........Linin ma+erial.. 7 Size; Diameter....._„c ..�
<br />.r g .. ; ..�, ....Depth...,.-�.,.........__.-......_..-
<br />Cesspool: Distance from nearest well ... _............ -Distance from foundation ...... -............. Lining material.. .... ........ . .. ..............:ienth...._......,................. _..-,._.........._._.Liquid Capacty..-__.,...•. gels.
<br />Distance from nearest well ...... ....................................Distance from nearest building......,-.., ......___---
<br />❑ �, Distance to nearest lot line......,_ .......................... _............_...
<br />emodeling and/or repair escribe)..... .y
<br />.................... ....._ .. 1 r x .........� . .:........ .. _._ ....__.. � ._._...... ...............,.
<br />._...._. ......... ......_......_........... .. ......., ............_.......- -- ...................... ......
<br />I hereby certify that I e prepared this application and that the work will 6 done in accordance with San 36"Wn cmmty
<br />ordinances. State la ; and Its and regulations of the San Joaquin Local Health District.
<br />Si ned
<br />g ) - - d' ........... �rat,
<br />...(Owner and/or Contractor)
<br />- ......(Titley------.-._....---(Piot plan, showing size of lot, location of sysem n
<br />tiowalls, buildings, etc, can be placed on reverse sie§ey.
<br />FOR DEPARTMENT USE ONLY
<br />APPLICATION ACCEPTED BY,.-,,/ �. .....,.........
<br />� CfRTE...�'l r 3
<br />.....,. ._.. ........................................
<br />_ ...
<br />REVIEWEDBY,....... ......................_.._..-_......_........_.........,....................... .......................... DATE ...._...-- ....
<br />..---.............,...................
<br />BUILDINGPERMIT ISSUED------------------- _ ---- -._....._...................... ._................ w ...... ........ ......... D,ATE............ ............._.....__.................., ......
<br />Allike
<br />rations and/or recornmend'ations: .._............ _.-.......... ............ ........ _.................... ...................... ........... -...-...... ._._.......
<br />,........... - ..........
<br />FINAL INSPECTION 8 A ............................. Date.. ............. .. ................. I.............
<br />SAN JOAQUIN LOCAL HEALTH DISTRICT
<br />130 South American 5trgi 300 West Oak Street 134 Sycamore Street 20S Wsst 9th %tree#
<br />Stackion, California Logi, California Manteca, colifornio Tracy, California
<br />ES 9 REVISED 8.59 2M 5-62 ATLAS '
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