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rvK UI-FICC USE: --------------------------------7777-- ------- --------------------- -- .. _ APPLICATION FOR SANITATION PERMIT Permit No. _45.12-w/ D3 ---- - �--- -- -- .. ....---- -- -------- -------- --------- --- (Complete-in Duplicate) --- ----- -- ------- ----- '` This Permit Ex fres 1 Year FromDate Issued Date issued 42 _/1 •�� Application is hereby made.jo 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 ------------- -51 11 -- Owner's Name.------ ----- •---------- � ° 7777-- 7777-- --7777--7 777-7777 .- Address it - - -------------------------------------- ------ Phone------ ------------ --------------- ------------- ----- -- J c. r & --•-----•-- ........3------------------------------------- - Contractor's Name------- ---• ----------- -- --• ----- ---7777-- -- ` -—�•- ------ Phone------ •------ --------------- El Tr ----Court ❑ ❑ Other Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel Number of living units: -/t- Number(of bedrooms. �� y -- .. Number of baths 77777777 Lot size __-_� 7777 - - --------- Water Supply: Public system Community system [] Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth lof 3 feet- Sand ❑ Gravel ❑ Sandy Loam Z Clay Loam [] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: '(If yes,date--- _---7777__7777 I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public._sewer�is araileblerwitliin;_200 feet.) Septic.Tank: Distance,from nearest well_._--------� --Distance from foundation--------------------MaterialEl No. of compartments-----------------7--.__._.Size-----••------=------ -----------Liquid depth_.._._.-- ------ �F Capacity Dispos Field: Distance from nearest weii_ �:_._.._Distance from foundation_____Zd_-r--...Distance to nearest lot line_-s_,-7777___ Number of lines --.------f--- .:_ ,.,,_1=---.Length-of each line-- ---, -Od X--------Width of french-.---:Z„--!----- Type of filter material-------Si!_C!.__..-Depth of filter maferial....../�.___ r� ----...Total length-------4!0 ---------------------- Seepage `U Pit: Distance to nearest well ❑ Number of pits___ ---------- from _ foundation____________________Distance to nearest lot line----------------- Lining materiel -__1__ ------.- Size: Diameter----------------- ----- Depth--------------------------- Cesspool: Distance from nearest well A l-------------Distance from foundation------------ . Lining material-_._._-------------------------- I❑ Size: Diarrieter- -- --- 7777 7777 -}-- 7777 ----Depth7777-� 777777 77-7777-- -.Liquid Capacity . Priv ------ gals. - q p - �7------------------------ , Y: Distance from nearest weN_._-77-_.----7:-_7- - - -_- Distance from nearest building Distance to nearest lot line--------- ----------------------------- - ---- 7777-- - :. -------------7777-- 7777---- ------ Remodeling and/or repairing.+describe I s --- ----�--------------F 7777- --)• ------ - -. .�- ---------------------------------%------------ --- --7777-----•---7777- -----------•--- ----------------------------------------------------7777-- -------------------- ---------- ' ----------------------- --------7777---7777---7777-- --------- - ------------------------------ -- - - ---------7777-7777- -- ---7777----------7777--------------- ----------------------- I ----------------•----- - -------•------------i------A----------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that,the work rwili be done in accordance with San Joaquin County ordinances, State s,and rules and regulations of tfie San Joaquin Local Health District. e (Si ned 9 )77777777-- -- -- -7777-- - --- -- - --- 7777-- -----------�--- - � and/or Contractor) 8y:..- -`" --- ------ ----- - .._ �__ ---- Ie� 7777. .{Tit r (Piot plan, sh ing size of lot, Foca ton of sy, tem in relation to wells, buildings, etc., can be placed on reverse side). Il FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY:_._. _ --- - -7777-- �- DATE REVIEWED 8Y i---------------- --------------------------- = - --- DATE__...- -----�---- 77 77--7777.- BUILDING PERMIT ISSUED---777,,7 7777 - 7777- -7777-- -----------7777-- ---------•--- - -7777-- --7777-- --7777-- -7777-- DA-TE------ Alterations7777- 7777-- 7777-- -------7777-- ,. 777777 77--7777-- --- --- - , and/or recommendefions-------- -- ._ 777 7--7777-- 7777-- - --------- 77-7777-- --7777-- ---------- --- -- 7777-- - � 7777 --- - �---- -- -- 7777 ---7777-- ----�..--- .7777-- --------------- 777--------- ----------------- ---- ------7777-- �----- - FINAL INSPECTION BY: : Date ,i 7777.----�- �---7777- 7777• • - • -7777-- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. it 300 West Oak Street 124 Sycamore Street 20,5 West 9th Street i $ocklon,California Lodi. California Manteca,California E.H,92M 1-67 Vanguard Press % Tracy,California i