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FOR OFFICE USE: -. ------ - ... ....... -------------- PermitAPPLICATION FOR SANITATION PERMIT ----------------- (Complete in Duplicate) Date lssued �4 This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, This application is made in compliance with County Or�nance No. 549. ------ ---------- C TI --------- ---------------------------- ---------------------- - ----- ------- --------- JOB ADDRESS AND --------- Phone------------------------------------ Na� ... -—-------------------------------- Owner's Name- ---- ------- .. .... - ----------------------------------------------------------------------------------------------------------- Address------ - -4a,%4 Contractor's Name----�j�------ --------------------------------------------------------------------------------------- Phone......--------------------------- Installation will serve: Residence El Apartment House El Commercial 0 Trailer Court EI—Motel 'Other El 0--- Number of bedrooms 10 Number of baths -/&- Lot size --------------------------- Number of living units:/ Water Supply: Public system F1 Community system El Private p� epth to Wafer Table tt- Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam El Clay Loam [I Clay [] Adobe pe-'Hardpan E] Previous Application Made: (if yesdate-------- ------ No Pq" Now Construction: Yes Ej No [ FHA/VA: Yes D No TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Sep -----------Distanceromounn------------------- -- ffoundation_____-_____-____-Material---------------- --------------------------- ------ --------- ----- No. of compartments------------ ...........Size--------------------------------Liquid depAh--------------------------Capacity fi -- M� Distance from nearest well------1 r - t lot I i ne: ...... Disposal Distance from nearest well__ --------Distance from foundation--A?--1---------Distance to neares f each line-�t�o` --------VI-pt-If----- --- p Number of lines-------t--------------- ----------Length o --------------------Width of trench ------ -1 F1 d --Total length---v,, -6-F ------------------ Type of filter material-717?�-CA-----------Depth of filter material---------------- Distance to nearest lot line--- Seepage Pit: Distance to nearest well -40b.---------Distance from founclationA?. mefer---1 ---- --------Depth- -2--ly------------------- Number of pits--A____----------Lining material- -----Size: Dia cesspool: Distance from nearest well"r--------------Distance from foundation.-.---------------- Lining material__.____.___--------- Diameter---- -------------------------------Depth-------------: ----------------------------------Liquid Capacity—-------------------------g als. ❑ Distance from nearest building---------------------------- f` uilding - �------------------------------------ - nwell------------------------------------ Privy: Distance fromi earest ---------------- ---------------- ---------------------- --------❑ ---- Distance to nearest lot 1�ne---------------- ---------- -- ----------------------------- -------------------------------------------•-------------------------------------------------------- aA/o:r repairing (desiribe):--------------------------------------------------- Remodelin' I ------------------------... ------------------------------------------------------------------------------- ------------------------------------- -----------------I-----a-------------------------------------I---------I-------I--------------------------------------------------------------------------------------------------------- ------------------------- ----------I----------------------t- ---------------------------------------------------------------------------------------------------------------------------------------------- --------------- 11 hereby certify that I ha 0 Prepared this application and that the work will be-done in accordance with San Joaquin County S I aquin Local Health District. ordinances, State laws, and e nd Lregulafi�o�tf an -, :,.r ----------------------...(Owner and/or Contractor) ------------------- ---------- (Signed)-------------------'---- ------------------ Ii ...............................................................-(Title)------------------------- ---------- ......... By:----------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells. buildings, etc., can be placed an reverse side). F R DEPARTMENT USE ONLY A�d------------------- ------ APPLICATION ACCEPTED BY---_,J --------------------- -------------------- DATE........�':7,---------------------- REVIEWEDBY--------------------------- ----T --- --- ------------------- --------- ------------ --------------------------- DATE-------------- --------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------- ------------- ----- --------- DATE ----------------------------------- 7--------------- Alterations and/or recommendations:_____...:_ ----------�5�k--- ----------oze I- - ----------------------- ----------------------- ------------ --------- ----------------------------------I----------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- ----------- -----------I------------ ------------ --------------------- --------------------------------------------------------------- ------------------------- ------------- --------------------- ------------------------- ---------- - ---------------------------- ---------- --------------------------- - --------- ----------------------------- ........... --------------------- ----------------- --------------- -----11............i--------- ----- - -------- ------------- --------------------- ----I-------------------- ---------------------------------- ------ ------------------- - FINAL INSPECTION BY--- -------- ---------------- --- Date-------Zig.......IZA-66..------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha.x-olton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocmon,California Lodi,California Manteca,California Tracy,California F.P.CO.