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APPLICATION FOR SANITATION PERMIT-, Permit No, <br />(Complete in Duplicate) <br />C/ <br />Date issued ... <br />7 — 2- -0 1 <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and1i 0 nsfgll the work herein described. <br />17 This application is made in 'compliance with County Ordinancp No. 549. <br />Z C�e f <br />2— <br />""C'q ZIT 10' N <br />JOB ADDRESS AND"Lo <br />Owner's <br />.............. ----------- .......... .............. <br />, w -W .. ..... Phone ............................. <br />Address ....... veo- ....... <br />... .......... /-') --------- <br />; ----------------------------------------- * ........................ <br />Contractor's Name.............. 16 <br />------------- Phone.. ----•-•-• <br />Installation will serve: Residence.El Apar+ment House fj Commercial E)'.'Trailer Court El M fel Other <br />❑ <br />Number of living units: Number of bedroom -5 I/ Number of baths ji- Lot size <br />Water Supply: Public system ❑ Community sysfem,Private ] Depth to Water Table/?;`4" <br />Character of soil to a depth of 3 feet.' Sand "E] G -ravel E] Sandy Loam [] Clay Loam [:] Clay ❑ Adcbe4a-Fiardpan [ <br />Previous 4plicaflon Made: Yes ❑ No �New'Construction : Yes E] No FHA/VA: Yes D No W�" <br />TYPE OF INSTALLATION AND SPECIFICATIONS. <br />(No septic tank or' cesspool permitted if public sewer isavailable within 200 feet.) <br />Septi _Tank: <br />Distance from nearest well-. -------- <br />. Distance from foundation ......... ... ..... Material <br />No. of compartments-,..., ---_--------- Size--------- ---------- <br />_------- Liquid depth...... ....... Capacity-... ----------- - ----- <br />rDisp9p,11 Field: Distance fronearest well .... .... ...... Distance from foundal, . ion .. ................. Distance to nearest lot line--_! <br />Number of lines--_- ------------------_------- Length of each ............. ......Width of french--------.._._:-. .-------------•-. <br />Type <br />rench------ -- <br />Type of r';lter material, ........... .......... Depth <br />of filter material ... _ -------- __Totaf Iength_ ....... ......... <br />*pa Pit: D'stance to nearesl'well.//V --- ......Distance from fou 'Nip to nearest lot line. <br />ining material/ —size: D:ame`er_ Depth .... _.210 ------ <br />Number of pits..-.-/ ....... <br />-_ 'V� fou <br />Cesspool: Distance *rorn neares[.well ................Distance from foundation. . .............. Lining material...__:___..........._.___._.----.-_ <br />F-1 Size: Diameter. ...... .-----..Depth...-.-----•-----------------------_- - I ------Liquid Capacity............---- •-------- gals. <br />Privy: Distance from nearest well..- ------------------ - --------------- .. Distance from nearest building ._ ....................................... <br />El Distance to nearest !of line...------- -- <br />----- <br />Remodeling and/or repairing (describe): .............. .....-•--.....-__...........--_--.---... I <br />­_ <br />--------- ----- ! ----- <br />------- <br />----------------------------- -------- ------------------------ ----------------- -- <br />------------------- ----------- .. ...................................... -- <br />----- ....... ----------- ...... -------------- ......... <br />.......... <br />... -------- ....... ............................ <br />........................................................................ -------- ---- ---------- .......... ------------- .......... ................................ ...... ­ ......... ................ .. ii� <br />...... .............. ....... ................. .... L ................................ ......... -------------­--- -------------------- ................... .... ................. ------ ----------- .......... --- <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and ules and regul tions of fh San Joaquin Local ealth District. <br />o7 <br />1 <br />.1 <br />(Signed). ---- -- ---- ... QA _RA — <br />..... ---------------- (G4"er-an4j,*r Contractor) <br />By: --------------------------•It - ------- <br />----------------- - ------------------ Title) ... l...t�16%111�1� ------- —... <br />(Plot plan, showing size o location of system in relation to wells, buildings, etc., can be placed on reversil!Prsilde). <br />.. . ..... ........ . <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY-... <br />- ------------_ ......................................... DATE----------..----- <br />REVIEWED <br />ATE----------- .......REVIEWED BY ---- -- .......... e' <br />. ......... qy_ <br />BUILDING PERMIT ISSUED---.----- .............. .............. ................. DATE _.­___/ --- --------------- -•--•--,-- <br />­ ------ ....... 1 ........... ................... DATE-----....... .... <br />Alterations and/or recommendations;— ------------_----- <br />.................................. <br />-I--r ------------• ....... if ------- --A-.v .............. .......... . ------ I ---- ---- <br />.................. ------ ---------------- ------ <br />W Od ... - -4r.=. -,UI <br />.................... ....... ­ ...................... ­_­ ---------- ------------- ........... ................................. L.", tl <br />----------- ......................... ........ .......... <br />.................. .............. ----- ------------------- -----.-..............-------------•---•••.-------- ............ ----------- ............... ......... ---­-------- <br />• <br />FINAL f IN S P E -C T 10 N BY:.-.. Date ..... <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Stre-ofI- <br />300 West Oak Straef 132 Sycamore Street 814 North "C" Street <br />Stockfon, California Lodi, California y Maniacs. California Tracy, California <br />ES -9-2M Revised 1-57 F.P.CO. <br />