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-.FOR OFMCE UST. I <br /> ------------------- <br /> l� --------------- ��' 'T--••-• --m --- <br /> � . APPLICATION FOR SANITATION PERMIT � Ps�mit No. ��� _ <br /> ----- "a '# <br /> ---- ------------ ----------------------------- (Complete In Duplicate) <br /> " Date Issued .-� ___ i <br /> _�_ _________________________________ �� This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for PP Y q permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. G� s- yj a, , a <br /> TION--- - - -- - <br /> ---- -------------------------------•----------------------- <br /> JOB ADDRESS AN , , � � --- <br /> Owner's Name------ ----------- T----------- -----_------------------------------ .._ Phone---- ----- <br /> Address -----------"----'-----------` G�,�{'_5 � <br /> - ----- <br /> Contractor's Name -- - --y- !< - -------------------------------- Phone---1 %- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial �siler Court ❑ Motel ❑ Other [❑ <br /> Number of living units: ___'"'Number of bedrooms __._ Number of baths __y_ Lot size _f,%�__�' �`____--:-.—_______________ <br /> Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table -------- ft_ <br />'4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ 'Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,.date--------------- No [ New Construction: Yes [t"�'No ❑ FHA/VA: Yes ❑ No ®— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: w <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest welf----- '___.__Distance from P foundation+___.___�_______.Matenal._� 5 ____ <br /> No. o' com artn4ents_____.•� Size <br /> �YIA X__.�'_-_Liquid depth__.-t�Ot-*_______Capacity__f L%�4-- � <br /> Disposal Field: Distance from nearest well__ ___._Distance from foundation'�S---------------D' t nce to nearest lot ling__✓ -�'____ <br /> Number of lines___" __________ _ ___________Length of each line"?!��_s�' �i ath of trench_._._,,� _`?'_____________-__ <br /> c�/,� o <br /> Type of filter material____a/ - ___Depth of filter matenal___� ._____--_-_Total length-------E'�,1_______ _________ <br /> See�p.a.�/ge Pit: Distance to nearest well-----—------------Distance fr foundatibn___#Z�------Distance to nearest lot,line__-t___-__ <br /> LrJ Number of pits._!_�'_________Lining material__ Gp/ Size: Qiameter `_ ---------Depth--,.__-_ ------ <br /> Cesspool: �. Distance from nearest well-----------------Distance from foundation---________________Lining material_-___--_...._...____._________.___. N, <br /> ❑ Size: Diameter----I----------------------- -------- Depth------- --------------------�- ---------------Liquid Capacity-.-.------------------------gals, <br /> Privy: Distance from nearest well___------------________­_:€------- --- --_-_.Distance from nearest building.___.__________._.____.________.____._-- <br /> ❑ Distance to nearest lot line------ ------------'---=- . .... --------4----=------------------------------- ------------------------------------------ -------- <br /> L <br /> Remodeling and/or re airing (describe):__.____ ___ <br /> ----------------------------------------------------=---------- ------•--•-----•-------------------------------------------- <br /> ------------------------ -----------------------------------------------•---------------------------- -----------------.-�--------------------------------------------------------------------------------------------- <br /> � - i <br /> -----------------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------ - ---- - -- - <br /> I hereby certify that I have prepared this application and that a wo kwill be done in accordance with San Joaquin County <br /> ordinances, State la rules and regulations of the Sa oaq in Laca Health District. ! <br /> 1 <br /> {Signed} � � / ��� - /�___��---- - ------------------------ 4- neand/or Contractor) <br /> B :Y - -•=-----------------------------•---------------------------------------{Title}----- ----- -' -- ----- - - - -----..---- ' <br /> (Plot plan, showing size of lot, lata ' of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> i <br /> FO�R7 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------___1---------_.___-___._(/------------------------------ ---------------------------------- DATE-- -- �� <br /> ---�� - --------------------- <br /> REVIEWEDBY------------------------------------------- - ------------------ ----------- ---- ------------------------------------------ DATE----- ----------------------------------•------------------ <br /> BUILDING PERMIT ISSUED-------------------- ------------------------------ E <br /> Alterations and/or recommendations: /�.3/� -- �� .l �✓---------------------------------------------- ---------------- <br /> ---------------- ----------------------------------- --------- - ------------------------ ------------------------------------------------------------------------------------- <br /> -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> ------- <br /> --- ------------------------------------------------------------------------------------------------------------------------------------ -.._...___ _ <br /> ---------------------------------------------------------------1------------------'----------------------------------------------------------------•------------------------...-------------------------'---------------- <br /> •� a Y � <br /> FINAL INSPECTION BY:.------ ----------- ------------ -A�C�- Date-------------- --- ------------- -- ---- ------ ------- <br /> SAN <br /> -----SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stotkton,California Lodi,California Manteca,California Tracy,California <br /> F.P.Co. <br /> 9 <br />