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FOR OFFICE USE: 4F <br /> -G ----- ---------------���` 1 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------- <br />----------------- ----------------------- -------------- (Complete in Duplicate) — <br />________________________..--.".---..------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued �l'_"---"_ ----__ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta4l the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ' <br /> JOB ADDRESS AND LOCATION------ T .Z-3� •_ ��} �� t " 1'1------------------------------------------------------------------------- <br /> Owner's Name---------- _" _1 : " ----------------------------- one ---------- <br /> Ph v4— _9 <br /> r � <br /> Address __- •-•---.. <br /> sf <br /> Contractor's ,Name =. �a "� ?t C "---------- Phone--� _7.76 7. <br /> Installation will serve: Residenc4 TK Apartment House []__Commercial E] Trailer Court [I ofek d Other ❑ <br /> g --- ` bedrooms -• tuber of baths - ___-- Lot site - -•- -- ---------------- <br /> Number of livor units: ___.__-- Num er of bedrooms -____- -�---� - <br /> Water Supply.'-Public system i❑ Community system [I Private Depth to Water Table "-"_" ff <br /> Charact of soil to a depthroff3 feel) Sand ❑ Gravel [] Sandy Loam F­1Clay Loam ❑ Clay ❑ Adobe. Hardpan C] <br /> Previous Application Made:i if yes,date----------I-------�..No © New Construction: As ❑ JNo ❑ JA/VA: Yes E] No ❑ <br /> TYPE OF INSTALLATION AND-tSPECIFICATIONS p4 <br /> (No septic tank or cesspool permitted if i <br /> ublic sewer is'`available within 200 feet:) at <br /> Se tic Tank: Distance frneatest ll -"""""."-r _Distarice from foundati -------- --- -....Material.--..---"_".----__---_--...""._"_ _----_._-_-. <br /> P it _ _Al iisfan elf lm fo ndatioln <br /> ❑ P ,� h--------- --.Capacity----------------------- <br /> ,J_j� <br /> Field: Distant f orri ea est well.__----"..._Distance rf u.:__ q p -_.Distance to nearest lot line � _r_ <br /> L�CiST <br /> g achlime--- Width of trench. a ' <br /> YP P <br /> NumberEof lines---" _""""� Jai <br /> T e of ilter4nat#�rial-- :De th off Her material f Total length ------ i <br /> �?3 ,r Ov <br /> Seepage Pit: Distance to Barest well-.- tancefro fo dation_""_"_ . -___----. i�tar�ce to neares. of line - ---_ <br /> Number of pits-----I --------. --Lining4material___ Size: Diameter -- {,�� _.Dept -------;?U�'-- <br /> �.: - - D m fAu dation- --------- ....Lining maferial -•----------------------------------- <br /> --------- <br /> Cesspool: SDizea D ameter neares# well- -- """ --Dep ce from ----Liquid Caka ty----------------------------gals. , <br /> Y M <br /> Privy: Distance from nearest well--, . ----- - " -.--- -ice from #Barest.building---- .-.--_._- <br /> " ( � <br /> ❑ Distance to nearest lot line--------------------------`----------------�------------------------4 ---------} ------ <br /> I <br /> � . -- ry <br /> Remodeling a�/or repairing (descrE �:""__- _� - ___ �, ,r; � <br /> ------__ ---- - ----------- <br /> ---- -- �J wiz--- <br /> ------•------ - - `R---------------- - �-��- -------------------------------- <br /> -------------------------- ----------- <br /> --------- ---------- •------ ------------------------- ----- '' = <br /> ! --------- - - ------------------------------- <br /> f ' --i ---- -) ---------------------------------- <br /> --------------------------'-------------------------------------------------•-_ ___--------- -""""-_ ..� i <br /> I hereby certify that I have prepared this application anthat the work will be done ern accordance:with San Joaquin County <br /> ordinances, State laws, and ru and regulatioAs of .he San Ooaquin Local/ Health District. +� <br /> r `1 F 4 <br /> c �/�/ h �' - `[Owner and/or Contractor) <br /> (Signed) f - '' �I <br /> Title { <br /> By------------------- :: - --------------------- [ i I= «; f <br /> (Plot plan, showing size o lot, locatio f system in relation to wells, buil dings, etc., can plac�edon revers side). <br /> 0" <br /> w x i <br /> F DEPARTMENT UStONLYI LA I # <br /> APPLICATION ACCEPTED BY--- --L�._ + - ----------- -------------------------------------------- 'DATE"�"'t�`�r E --------- ------------ <br /> REVIEWEDBY - ----------------------------------------- DATE--------------------r-•---- ---------------------------- <br /> BUILDINGPERMIT ISSUED------------- - - ------------ ---- ------ ----------•------------------------------------- TE------------------------------------------------•----------- t. <br /> Alterationsand/or recommendations---------------------------- ------------------------------------•-------------------------------------------------------------------------------•--------- <br /> f�=1 ' <br /> -------------------------------------- ----------------------------- ---, <br /> ---< <br /> -�+� / <br /> 4 j -------------- -j .....lee-?----- r a <br /> t I <br /> ------------------------------------------------------------------------------------------- - 4 <br /> FINAL INSPECTION BY:------ - . .. - - ------------- Date--... 1--1 t/j-•--• <br /> - ------- <br /> - . <br /> i S AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4rh Street . <br /> Lodi,California Manteca,California Tracy,California <br /> Stockton,California J,. <br /> F.R.C a. <br /> t <br />