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FOR OFFICE USE: ------------ -------------------- APPLICATION FOR SANITATION PERMIT Permit No. � ----------------------------- -------I-------------------- - (Complete in Duplicate) . Date Issued ,�_" 'I-�'-"- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and in all#hie work herein described. This application is made in compliance wit nty,,9nance No. 549. _ .- JOB ADDRESS ND LOCATION---- --- Pho a----------•------------------------ ------------------------------------------- Owner's -- -- ------------- Owner's Name #M F 7 - ----------------------- -- Address •---- - ` �� vi"- - one---_------•-------- Contractor's Name_ _ _____..__ ----- -- - Commercial ❑ Trailer Court ❑ Motel ❑ "Other ,, Installation will serve: Residence Apartment House ❑ 12-0 ! X j.S"a /------------ Number of living units: _I_-__ Number of bedrooms ._______ Number of baths ___- --- Lot size ---------------- Number - ------- --- - Private Depth to Water Table _-___--- ft- f Water Supply: Public system ❑ Community system ❑ Hardpan '� ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ��ay Loam ❑ Clay ❑ Adobe❑ j �r j Previous Application Made: (If yes,date__---- _-------) No C] New Construction: Yes ❑ Na E] FHA/VA: Yes E] No [IPrev PP TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.}` au Septic nk: Distance from nearest well-_45-4.... --Distance from foundLn_uid de th__M Material 4- ------ -C p uty_J_`" __ ---- --- -- { lF No. of compartments______"_`_��---------Size_ -�---� - -X----- q p• Dispos Meld: Distance from nearest well----- .;67-7 -t Distance from foundation- - -j W��th ofttrenche$ %line-------_: ---_-- Number of lines______ - Length of each line__ - ' ......... , d Depth of filter material ___-l-_`�_ ____-Total length__. -2.&------------------------- Type of filter material -�-.---- -- Seepage Pit: Distance to nearest well---_-__Linin material Distance from foundZ£npiameter_ ----stance to nearest lot line.--._---_---•-- ❑ Number of pits------------- g ing Cesspo l: Distance from nearest well_________________Distance from foundation---.---------- Lining material gals• Depth------------ - ----------------------------------- Q Capacity Size: Diameter-----------•••--------- - yDistance from'nearest building----------------------------------- -- Priv i; Distance from nearest well._---_-__"------- ""---- a_�. - - ----------- . ... -------- - ----------------- ----- D3stance to nearest lot line-----------------� -- - i, - I ... �,• a _ �___________________"-_______-___-______________-_________-________-_______--._-___-______________.. Remodeling and/or repairing (describe:- '= - . -------------------------- _________________ ___________________________________________________________ k - -- ------- -------------------------------------- 1 h I------------------------- ---------------------------------------,---- -- -- ------------" ----- ------------ -- ----------------•---'----"----------1------------------------------------------ I--hereby certify that I have prepared this,app&ation and that the work will be done in accordance with San Joaquin Count>y��► - ordinances, Stat aws, and rules and regulations of ahe San Joaquin"Local Health District. ' x and/or Contract d = --------- (Signe of lot location o- system m relation to wells,"b" .-(Title)----------------------- - 1� By:-----(;- ------ ---- -----I------- -- (Plottplan, showing size uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------ DATE--- APPLICATION ACCEPTED BY ------------------------- ---- --- DATE--------------------------------------------------------- REVIEWED BY------------------------------------------ -------------------- ------------- BUILDING PERMIT ISSUED------------------------------------------------ ---- -- -------------------- ----- ------- -------- --------- DATE------------------------------------ ------ ------------- -------- -- Alterations and/or recommen ations:__- -------------- - ----------=---------- L I -- -=---------------------- - ---------------- -------------------------------- -------•---------------------------------------------- ----------•--- -------------- --•------------ ----------------------- ---------------------- I FINAL INSPECTION BY:_ Dafie--------------Zd ------•--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.CO.