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FOR OFFICE USE: ------ ------------" ------- "------------ ------------ APPLICATION FOR SANITATION PERMIT permit No. ./. (�{x ------------ - (complete--------------------------- Com lets in Duplicate)p ) Dafie Issued -"--"- ----------- This Permit Expires 1 Year From Date Issued - -- -------- Application is hereby made to the San Joaquin ountcaOrdenafnceDlNoC 5491.a permit to construct and install the work herein �c��•f This application is mad�� cf,°mbliance with Y ,• `' � � r i � .A�"►s('� � IJP---�--------° JOB ADDRESS AV LOCATION- e ''" - .�. , ---------------- ------------ Phon r • ------ --- --------------- Owner's Name----- -- -- -- -- ---- +� Address------ - ---- ----- ---- - ---- - ,L- c R 7 "-- `� one. ----------------------- ---------- - ----•----- M Ph ---- ---- --- Contrac+or`s Name--------- -------- .._- Other �Y Apartment House ❑ Commercial 2('Trailer Court EI Motel ❑ Installation will serve: Residence,❑ p ---_----"---_""_ Number of living units: ---0- Number of bedrooms --_--- Number of baths-= ---- Lot size __.-- --•------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to ager Table yft Adobe ❑ Hardpan ❑ feet: Sand Gravel ❑ Sandy Loam Clay Loam Cla ❑ Character of soil to a depth of 3 ❑ FHA/VA: Yes ❑ No El Previous Application Made: (If yes,date--------------- ----) No F1 New Construction: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Material""--_. -.-___ .- ----- Septic nk: Distance from nearest well----S '_-----Distance from faundation____� - Capacity _e �� i No. of compartments""�,�• Size iL�pA � --ZVLiqu=d depth--- -------- p y•-- ,ar t lot ne pispas eld: Distance from-nearest well---Ae-1-__-._Distance from found ation--__ "`_-- Distance ,dth ofttrench�s2- 1ne-- ------------ ,Number of lines------_�"------------------Length of each line--." - -• e th of filter material ----.Total length-- �-------------------- •---- Type of1filter m �+---f� Depth p k. Seepage Pit: Distance to nearest well--.--__-------_..---Distance from foundation--------------------Distance to nearest lot line_" . ' f its.-. Lining material---------- ------------Size: Diameter-----------------------Depth-.- -------------------------- . ❑ Number o p Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--._-----_--.------------------ als. s Depth Liquid Capacity...-----------------------g 1 ❑ Size: Diameter----------------------------------- p Distance from nearest building - ------ - ------ - ------- ----- --- Privy: Distance from nearest well-----------------------------_ - ., Distance to nearest lot ine___---_"._---------------- ---------- Jr Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------------------- = --------------- '1 -•---•------------------------------�---------------------------------------------- ____' ----------------------------------- 0•----. .. Ir' a - - -__-_"- _••--•__------•--_--------"-----------------"-------------_-------•-------------__-.---__---_-_"-_"--"_"-__---"__--_-.----.-"."-__ - -------------- _------------- - - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State MWSn rules and regulations of the San Joaquin Local Health District. nd/or Contract4 (Signed) - -------- - - --- '�-t-�.._� --- --------------(Title)------ ------- --------•--------- ----- -- -- --- - - - (Plot plant, showing size of lot, location of system in rel tion to we , buildings, etc., can be placed on reverse si �. - FOR DEPARTMENT USE ONLY -^ ------------------------------------------------- REVIEWED - DATE---_— - .� --------------------------- - Yt1lY 'CJ!'% - ----------------------------- APPLICATION ACCEPTED BY�-------- ,''{� - -•- - -------- "---- DATE----------------------------------------------------- ----------------------------------- REVIEWEDBY------------------------ -------"-----=---- ------ ------ --------- - -- - BUILDING PERMIT ISSUED----------------------->------------------------- -------- ------------------------------------------ DA-TE---- Alterations ATE-- -Alterations and/or recommendations:---------------------- -----------------------•---- --------------- - ---------------------------------I--------- ------------------------- ----------------------- Date.- FINAL INSPECTION BY., -------------- -------------- . -p- ' " . ------------------- 5AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Ntantecar California Tracy,California Stockton,California ES 9 REVISLO a-59 3M 3--53 F.P.CO. 5