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FOR OFFICE USE: - " 7------------------:K- --- APPLICATION FOR SANITATION PERMIT Permit No. ._cy�� - f ------- - -- ------- ------ ----------------------------- (Complete-in Duplicate) _ 1> .� ___.------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 OrdinanceNo�. 49. JOB ADDRESS : AND�ATION----Qs��--�,��.----`-"-.�'� �- ----------••-•----- ------------------------------------ --- -------•----------------------- Phone.Owner's Name---------- �` Address----- -?.----- -- ---------------------- - - ----- ------------------------------------------ ----------------------------------- ---------•------••---- Contractor's Name_______ Phone--------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 'Oler %3 Number of living units: _f__ Number of bedrooms _&2- - Number of baths_/__ Lot size / ._ -,� -�J-----------------------� 1 I Water Supply: Public system Community system [I Private El Depth to,Water Table -ft. Character of soil to a depth of 3#eet: Sand E] Gravel El Sandy Loam [I Clay Loam El ❑ Adobe Hardpan Previous Application Made: (If yes)ciate ---------- ) No 2?"New Construction: Yes ❑ No 8'FHA%VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet:) Septic Tank- Distance from nearest well---------------_Distance from foundation--------Z_____._ -.Material.....____--______.-_-------__________._--____. f compartments ` No. o ----------------- __:____--_____.___Liquid depth---- ____---------_____--Capacity , ---- Size--------- - ----------------------- Disposal Field: Distance from nearest well_- Distance from foundation-- ........Distance to nearest low Number of lines---------- - -- Length`of each line-----� ---------_-- ---Width of trench.. --- ------------.---------- � ' Type of filter materiai �_Depth of filter materia!_ ` -------Total length---,_Lr----_------------------------ Seepage Pit: Distance to nearest well___._. —------Distance from fou dation______ ______---.Distance oto nearest lot lin ______.--______ ------Linin material-- � -Size': Diameter-- ,1___----_--Depth-�,�z --------------------- Number of pits._..__-�.__._ g Cesspool: Distance from nearest well-----------------Distance from foundation-..-___ -------Lining material------------------------------------- >a E-1 Size: Diameter- [--------------- -------------------Depth-------------- ------------------ ` '--------._Liquid Capacity gals. Privy: Distance from nearest well-----_---------_----------------__.-------------Distance from nearest building------.---------------------------------- ❑ Distance to neatest lot line------ ------------ --------------------------------------------------------------------- i 1 Remodeling and/or repairing (descfibe]:--_---- �� -- -- ----------------------------------------------------------------------------- I -------------------- --------------- ---------------------------- ----------•-----------------------------------------------------------•--- ___ __ It ----------------------------------------------------------------- ------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San'Joaquin Local Health District. I ------------ (Signed) ( ontractor ------------- B /' ' ---------------(Title}_ .- �® - -. -- . ------------ Y:----------------------------•--•--- ---•-- ------ ----- (Plot plan, showing size of lot, location of s S m in relation f. wells, buildings, etc., can be placed o reverse side). r R D. PARTMENT USE ONLY t APPLICATION ACCEPTED BY. ------------------------------------------------- DATE------------5-`--47 ►` DATE----------------- ------------------------------------ ----- REVIEWED BY------------------------------------ - --------- -- ----- ----- -- �;BUILDING PERMIT ISSUED------------- Z DATE---------------------------------------- -------------------- ------------------------------------------------------------------------------------- i {Alterations and/or recommendations------------------ -- --------------- - ------------------------------- ----------------------------•------------------- ------------------------- } I ------ -_------ - ------ ----- -------- ------ - - --------------------------------- -------- ------•-- --- ,� o _ lt.r �e-fir '� r T { �� ---- ----------- --- cL a ed_h /ve -------- - - fe J;{ M'`lG/F I ` t4r �-------0-4----- s�-------�`-= �' ,E . .: r - 10-er--------7V -------------------------------- - Date.-. - - ------ � --------------------------------- }` FINAL INSPECTION BY------------ - - -- -- -- - - - ----------- - ---�-..: ---- N JOAQ�IN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, i 300 West Oak Street 124 Sycamore Street + 205 West 9th Street f3 , Slocklon,California Lodi,California Manteca,California Tracy,California