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FOR ©FFICE USE:
<br />.,..»...... ................... ...»................. 1....
<br />_ APPLICATION FOR SANITATION PERMIT � Permit No.
<br />................. Y ......»`.................._, (Complete in Duplicate) Date Issued
<br />This iermit Expirels ExpiresI Year From Date Issued
<br />application 4 hereby mads to the Sail Joaquin Local Health District for a permit to construct and install the work herein described.
<br />This application is made in compliarsc��a `wit17 County t�rdin+u+Gs�_�
<br />308 ATaDRESS AND C Tlt>N.'•-•'r. J. '. ...... .... ,.»_._.-..................... I ... ......
<br />._,».»
<br />Owner's Name. � w... r. _...._...,..»_. »» ». ».._.. ».. »............».............. Phone ..........._...... ............ .....
<br />Address........ ..-._ b... .�.....,. «,..»r.....»... »».. » _, ....»»..,,_».....»..
<br />Contractor's Name ....... ._..__ •. ....... _. ......»» ....». Phew..........»...» .... »...».
<br />Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑lMotel'».. __ ......
<br />Number of living knits: ,J.. Number of bedrooms 2.e* Nurn6 f baths _ /_. Lot size �-...
<br />Water Supply: Public. system C1 Community system ❑ Private (/Depth to Water Table ......., ft.
<br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe [/Hardpan �]
<br />Previous Application Made. (if yes,date.............:„_...) No ❑ New Construction: Yes E] No ElFHA/VAt Yes ❑ No ❑ I
<br />„ + S
<br />TYPE OF INSTALLATION AND SPECIFICATIONS:
<br />„;(No septic tank or cesspool permitted jf public sewer is.available within 2W feet.)
<br />Septic Tank: Olstance from nearest well ...... ...... Distance from foundation ..................... Material ........... .......................................
<br />13 No. of compartments .... ............ ___Size
<br />_...Capacity.....................
<br />............ ,..».aLiquid deP
<br />Disposal Field: Distance from nearest well .»»....... _.....Distance from foundation ................ Distance to nearest lot line ....... .•.... ....
<br />( Number of lines ,...«.,..-H...-._.. -,-»«»--- Length Of each.line..». »_ _......_Width of trench. -----------4»»
<br />Type of filter material...... Depth of filter material.......................Total length..,..._.
<br />` i r
<br />See pag+� Pit- Distance to nearest weil...... P��»_-»-Distance fm oundation.-I °........ _Distan to nearest lot lir�e__.._..w_+.»...
<br />Number of pits- .-_..1 . ...Lining material--l-KA..».Size: Diameter..:..3.r... Depth..•.»....._ »».»,»»....
<br />Ig » .. »»,....... �.....».
<br />Cesspool. Distance ii-om nearest well .»»__...».., iiistaltce from foundation.. • ......_..•.... Linin ma aria
<br />❑ Size: Diameter.. ... .............»».....».D+ sih...........» »....»..,.......».r..._.._._,».Liquid Capacity... --
<br />Size: .,.»,.
<br />Privy: Distgnce from Barest well .... ............ w.Distance from nearest building»» ... "_. .» »«
<br />❑.. �« `” Distant"fits n W est`l "lin .a'.� r`."....• ..................... _, .. : .......
<br />+
<br />Remodeling ancior elfin e3esGrlba ..............
<br />.. ......».»...»....»..... .......,....»... � +t ..,.»....._.........«......»...».»», ._.. .., .»»....«« .,,
<br />_._...__.........._................ ................ I-- ......... I—— .....
<br />1 l *reb certify #hat I have prepared this applicat►on and that #� work win ba done in accordance with San Joaquen my
<br />ordinances. State Is. and rules and regulationof the San Joaquin local H*th Dilitrict.
<br />...»._........_.,.,..,._..K....... .........«........�, _ ...., .
<br />»......,..._ Qw wr and/or Contractor)
<br />By.•. » location of relation to wells, blaildirsgs. etc.. canbepkcW on W40M s�da ..............
<br />(Plot plan, showing size of lint, syst
<br />FOR DEPARTMENT 115E ONLY i
<br />APPLICATION ACCEPTED BY---ar . «..»_ .iW ........... ... .._ ....»..».» .» # ------------------ .. »».._
<br />REVIEWED BY .......... .._.__....,......... ...'............
<br />.__. »,»....»._..........»»»». »., .. .,« DT .»...,..,..». »._._.-.....................
<br />BUILDING PERMIT
<br />Alterations and/su
<br />.......... »»..Y.».....» .......,...».w.�.....�.»..» ..«,.»................... �.• ...�..«. - .'"�""...'""".r.»»,y,.....»........2......,».»...«.....«........._..
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<br />FINAL INSPECTION BY �f������� Ciao®"Z.."...`.._......_.,.._.......«...»�.«.«.,.._._...
<br />1 SAN JOA9UIN LOCAL HEALTH DISTRICT
<br />1601 I. Kaxailon Aver, 300 Wast Oak Street 124 Sycwnora StrtW 205 Woo 9th svoe
<br />tleskten, California Lodi, California Manteca, California Tracy, California
<br />,Mare
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