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OFFICE USE: �VN_ 617 Permit No.--------------------/. 30.. E,,"PLICATION FOR SANITATION PE[..-••� p ) f { / ----- - -- ---- ---- ----------------------- ---- (Complete in Du 4icate Date Issued --------"--""-------- ---- - -- This Permit Expires 1 Year From Date Issued ` - ---------------------------- lication is hereby made to the San Joaquin Local Health Dis roic fo a permit to construct and install the'work herein desc,ibed. This application is made in compliance with County Ordinancea ---•----------------- - --- ---------- JOB ADDRESS AND LOCATION IS Ji -' "`"` "� Phone = t 1_ °------ `'` Owner's Name___ .�'--- ----'"""' Address 1� ----- •--------- - - r Phone----------•• + S � ' ---------------- --- -- - --•------�� i Contractor's Name_________l�"' - Other Apartment House-E] Commercial ❑ Trailer Court ❑ ❑ ; Installation will serve: Residence ❑ P �'t ' -------------=---- Number of living units:/a--- Number of bedrooms _©_ Number of baths _fa_ Lot.size __`��`=---- --.----::-- -: r.Su 1 Public;sys#em ❑ Community system ❑ Private.❑ Depth to Water Table --- �ft Adobe ardpan ❑ Wate pp Y y Clay Loam ❑ Y ❑ Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sand Loam ❑ Y Previous Application Made: (If yes,date__---..__--"-- ) No New Construction: Yes ❑ No [ FNA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: within 200 feet.) t C (No septic tank or cesspool permitted.if public sewer is available Distance from nearest well-__.--.-----.Dizeance from foundatiLquid--depth--Material-._--_---_Capacity._____________________ $ept' anly�.a� , No. of compartmen#s____--. ��ll ` "C_ r ,Distance from foundation__7"Q-----------Distance to nearest lot line_ -- ----•- Disposal Field: Distance from nearest well_�__�":__._ -_ Width of trench--p-00--------------- ---------------------------- ---------- of lines-----#------------------- ------Length of each line--��3p---- - �, Type of.filter,materiae- -'� ------;Depth of filter.matenal__1 _r�-�--- Total length-------�--'----_•--•---•-------------- Number - 1 Distance om foundation_-_�_�:____',-.--.Distance to nearest lot linelo------•---• W •�C/f Size: Diameter:_ -- --- P sZ "---Depth Pit: well-4-6-0------------ Number of pits__,'.----------- - £ g Lining material- --------- nce from. nearest well_________________Distance from foundation__.._ " Linin materia__-" 4---;--�--- Cesspool: Dista ------Liquid Capacity gals' ❑ Siie: Diameter--------------------------------------Depth.----- ---------------------------- ----- -.. ---------------------------- Distance from.nearest well_______------------------------------------------ __________________ ----- --------Distance from nearest. Privy: ----- ------ --- l ----- ❑ Distance to nearest lot line-------------------_--.-- �.:--__�------- �, �. = ... Remodeling and/or re'pairin describe)---------------------- -------------------------.-- •-------------•------•---------•--------------' ,S g -------------------------------- ------------------------------------------------------------------- I --------------------------------- application and that the work will be done in accordance with San Joaqu ! hereby certify that I have prepared this in County ordinances, State laws, a d ides an regulations of the San Joa uin Local Health District. -(Owner an r Contract d/o (Si ned --- --------- --------- ------------ 9 e ---�` (Title) By_--------------------------_______ ___ (Plot plan, showing size of lot, laxation of system in .relation to wells, buildings, etc.,.can be placed on reverse side). e FOR DEPARTMENT USE-ONLY l --------------------------------------------------------------------- DATE__!;F� ------------------------- ---------- APPLICATION ACCEPTED BY--- _- _ ---- ---------REVIEWED BY---'------------------------------------------- ---------------•---•------- DATE------------------- �---------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- ---------------------------------------------------------- =----------------- DATE. Alterations and/or recommen ations:__..__..______. ------------•------- .. _________________________.—___.--._.___-.__..._. .___________--___-__-_.------------------------------ --------------- _____-_..___._-___,-___.___________________________..__ __________:_..___._____.-______-._______..____.-. s _____________________ .. ..___----__-_.__ ___________________ - ._._._-___.-____-------------------- __..____-___ Date ------- t-- - ----- FINAL INSPECTION BY:.___ .� --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 124 sycamore Street 205 West 9Th Street 1601 E.Hazelton Ave. 300 West Oak Street California Lodi,California Manteca,California Tracy, Stockton,California ES 9 RF-VIS EG 8-59 3M 3-'83 F.P.Ca. F,