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FOR OFFICE USE: ----------------------' Permit No. APPLICATION FOR SANITATION PERMIT (Complete-in Duplicate) Date Issued --- --- - --------------------------__----------------- This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and inst. II the work herein described. This application is made in compliance with County Ordinance No. 549. �f'7 4)30--C( Zj 4 JOB ADDRESS AND LOCATIONZD---AI-0�_ -- ._ �'' ---------------------- /, Owner's Name f- - -----•------- -- -------- ----- P - ne--------•--•------------•----------- �j �-- hone Address �,1--_0_I_..- 4 -3 r -------------- -.�� Contractor's Name c ' - - -----. Phone.-- •---------- Installation will serve: Residence [!r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ^� Number of living-units: --I--- Number of bedrooms -_-- Number of baths.__ZLot size _____ ___ ________ ________ ---------------------------------- Water Supply: Public system [*Community system ❑ Private ❑ Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand Gravel Sandy Loam Clay Loam UT la Adobe Hardpan Previous Application Made: (If yes,date_- --------------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ x ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well_..Jd_`.'Distance from foundat�on_1f�'_____--------Material __.c .--- ____._.___ ..._. ___. 1/ No. of compartments-______�_.........Size_ quid depth-----4-__ _. ------- Capacity.. Disposa Field:. Distance from nearest weli__. Q-..'__Distance from foundation___._/.Q.__-.____.Distance to nearest lot line_.__ ______ Number of lines.--..---- --'----------------- Length-of each:.line- =Z _`___SG_�-Width-of-trench-----X------------------------- Type of filter material____._ R_f._._-__-Depth of filter materiaL____f. ....______Total length__.______Z_8-11--/________________ See pa a Pit: Distance to nearest well-------1.da____-Distance from foundation---/__47-----------Distance to nearest lot line______ _________ ( Number of pits... ....�.......Lining material._.--- . ------- Size: Diameter..-_, .�--�_..____Depth---`�.-1____________________ Cesspool: Distance from nearest well ________________Distance from foundation,-..------------- - Lining,material....---____-_-__...._____._.__.____._ ❑ Size: Diameter. ---------- -- ---------------Depth--:----------`-{- ----------------- ' ---._:_Liquid Capacity----------- -9als. Privy: T Distance from nearestwell------------____________�._____-__._._ __.__Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line :---t'----- ---------------- --`---------- Remodeling and/or repairing (describe)-........----------------- ` r' ---------------------------------------------------------...-- '------------------------ ----- - -- --------------------• ------------------------------------------------------------------- -' __________ ----------____------------------------------------------------____.__-__________________________________._.._-__---.____________-_____.__---__ ____________________g_____-___...----.._____.____.___......__.--_ �o 1 hereby cer 'fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, and rules and regulations of the San Joaquin Local Health District. (Signed) _ _ /or Contractor) SY:--------- - --------------(Title)--------- - ' -------------- ------- (Plot plan, showing size of lot, location of ystem n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY JJ APPLICATION ACCEPTED BY_ - -'- ---------------------------------- ------------- DATE 1__ " --------- --------------- REVIEWEDBY------------------ ------ ------ ------------ - ' ---------------------- ----_------------------------------------------ DATE ` BUILDING PERMIT ISSUED--- ---- -- ----- ----------------- ------------------------------------------------------ DATE----------------------------------------------------------- t Alterations and/or recommendations:._..--'-----. . . ........ -----------r --- ---------------------------------- ------------------ ----------- ----------------------------------------- ....................---------------I----------------------- ' -_" ----------------'------------------------ ---------- ----- --------------------------------------------------------------•----------- ------------- -----------------------'- -''-'-'"-'-• -------'- .......... -----------"------------------------------------------------------- -------------------------- --------..._..---- ----------------------- FINAL INSPECTION BYDate ..L._..__ SAN JOAQUIN LOCAL HEALTH DISTRICT c h 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ,Vockton,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1.67 Vanguard Press