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FOR OFFICE USE: <br /> -------------------------------17.0--_61F <br /> - ------------- - - ----------- <br /> -- APPLICATION FOR SANITATION PERMIT Permit No. _4---J -- <br /> ----- - - <br /> --------------e.=-- ---------------- - ........ s (Comple4e.in Duplicate) Date Issued "Y/ <br /> ---------------------------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION-- <br /> ---------------------------------------- --------------------------------------------------------------------------- ---------- <br /> Owner's Name --------- .---•------------------••---- ----- -------------- - - ---------------------------------... Phone------------------------------------ <br /> k <br /> hone------------------------------------ <br /> Address <br /> ------------------------------------------------------------------------------------------------------------ I------------------------------------------ <br /> 4 <br /> Contractor's Name---1Z - -------------: <br /> ------- ----------------------------------------------- Phone----•- ---------------------------- <br /> Installation will serve: Residence @Er--Apartment House E] Commercial E] Trailer Court [] Motel [I Other ❑ <br /> Number of living units: --/----- Number of bedrooms _3__ Number of baths Lot size ---- <br /> Water Supply: Public system 2--Community system Ej Private E] Depth to Wafer Table��ft <br /> Character of soil to a depth of 3 feet- Sand F] Gravel 0 Sandy Loam [:] Clay Loam [:] Clay [] Adobe 0"Hardpan ❑ <br /> Previous Application Made:tjif yes,date-- I No �New Construction: Yes E] No 1?1FHA/VA: Yes El No ET—' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi a <br /> Septi Distance from nearest well_________________Distance from foundation--------------------Material ----------------- -- --------------------------- <br /> No. of compartments---- - ---- ------------Size-------------- ---- -----------Liquid depth-.------- ---- -- ------ Capacity----------------------- <br /> -10---------------Distance to nearest lot line___L57_,/.... <br /> Disposal ; Id: Distance from nearest well.- ....Distance from foundation <br /> 0%4 Number•of fines.______----________________________� �A <br /> K-r- Length of each line--.10--------4_:---------Width of french.1.1Z4_111--------------------- <br /> Type of filter maferial__.�FD'C-A......Depth of filter material---11----------------Total length____-- ------------------------- <br /> Seepage Pit Distance to nearest well------—_ Distance from foundation---/�t----------- Distance to nearest lot line__U`_ <br /> -,— ---------- <br /> Number of pits-.- ./------------.--Lining material------J71?C,_/�--- Size. Diameter----33-re--------Depth----_ -/-------------- <br /> I <br /> Cesspool- 'i 17 Distance from <br /> nearest <br /> well ------ --------Distance from foundation.......____._____ _.Lining material__._.__-___________._____----____._:. <br /> ------------- <br /> El Size: Diameter- --- -------------- --- - - -- --..Depth--------------- -----------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well__________________________________ - - .._._.Distance from nearest building____._.___._---------------_-------------. <br /> ❑ <br /> %Distance-to-nearest-lot line........ ---------- -------------------------------------------------------------------------------------- <br /> Remodeling and/of 'repairing (describe):------- --------------------------- ---------------------------------------------------------------------r-------------------------------- <br /> ................ <br /> ------------------------------------------------------ .. ...I=---------------------­­-------------------------------:----------------------------------------------------------------I-------------- <br /> ---------- <br /> ----------------------------- -------------------------------------------------------------------------------------------------------- ------------------------------ --------------------------- --------- ------ <br /> - ------------------:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ........ <br /> ,I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State' laws, and r es and regulations of the San Joaquin Local Health District. <br /> (Sioped)-----------------`---------- - - --------------- -------------------------------------------------------- --------------(Owner and/or Contractor) <br /> Illy:-------------i---------------------------------I--------7------ ----- -------------------------------------------------------------(Title)------------------ -­---------------- --------------- - - <br /> (Plot plan, showing' size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> R DEPARTMENT USE ONLY <br /> F ----------- <br /> APPLICATION ACCEPTED l3Y___._G_<. - ------------------------- <br /> DATE <br /> REVIEWED BY---------------------------------- I I­ --------------- ------------- 6__r----------------- <br /> ­------------------------------- ------------------------------- DATE <br /> BUILDING PERMIT ISSUED---------- --------- - DATE <br /> ------------------------------ ----------------------------- <br /> Alterations and/or recommendations:._.___+ ......... - -------------- <br /> -------------------------- ...... ---- ----- ........................... .. ----------------------------------------------------------------------------- ----- ----------------------------------------- <br /> ---------- ----------------- ------- -------------------k--------- - - --I-------- ------------------------------ --------------- ----------- -------------------- ---------------------- -------------------------—•--------- __ ---------------- ------------- - ---A------------------------------__------------ -------------- ----------- ---------------------------------- ----------- ------------------ -------------- <br /> ....... .............. - --- ----- -------I..............­---- ----- - ------------------------------- ------ <br /> FINAL INSPECTION BY:. Date. 1 <br /> ­ 7.......­_ ................ -------- <br /> SAN <br /> - ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street <br /> Slocklon,California Lodi. California Manteca,Corifqrnia Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />