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{ FOR OFFICE USE; 1 - ,( ---- ------...;e --- --�---- ------- f � APPLICATION FOR SANITATION PERMIT Permit No. 3 � ------- --1-7------------�-- - ----- (Complete-in Duplicate) This Permit Expires 1 Year From Date..Issued bate 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 Ordinance No.;549. i f o I JOB ADDRESS A LO ATION -aJ-Pa. NPrt_iZ. - ,roi Phone.-4" �f. ti Owner's Name------ Address----------------------�!�C / �'s°`�S -Q. --------- _NV ----------------------------------4 -- .......... i Contractor's Name- k' iE � Installation will serve: Residence ❑ Apartment House ❑ Commercial F] Trailer Court El Motel [:1Otheri& & Number of living units: -- ._-_-'Number of bedrooms -------- Nu giber of baths ..----- 1_04 -size __ ....?L / © i_ Water Supply: Publics stem �� PP Y� Y Community system ❑ Private � Depth to Water Tabls - - ft Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy Loam.EI—Clay.L•oarn❑ Clay ❑ Adobe o--<rdpan ❑ r Previous Application Made: (If yes,date_------------------ ) No ❑ New Construction: Yes ❑ No FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5e tic Tank: Distance from� near"est'ell _'_` u_ "" �' ti-�— P r��L-L_Distance frosm ff nndafiori_ /i r No. of:comp ttments--z------------------Siz q._Sd 91ff_-Liquid depth. -o1------- Capacify-1A'; _ Ar I Dispos I Field: Distance fromenear f'wellAfXlx.,.-Distance from foundaf - r-, ------Distance to nearest lot ]in e_-r.---. it 'Number of llines.: - 1 Length of each line- O.W id Ali of trench. ltt��---------- ---- Type of filter materia Dep#h;of- filter materiali,�- -�° ` Total length :./$1sP- ----- -- ` fe�.t s r r w y p pits . material . e�m"foundation-_�p_�.'" "lista to nearest lot Iinq:_. d See a e Pit: s plumber of nearest well.-� Distance fr, � �" q S i �. e: Diameter-- Pth • ar.� Cesspool: Distance from nearest well -_' _ Distance from foudaton................. ..Linin material ' l--------------------------- -•---. g ❑ Size: Diameter. .° w. _Depfih---- ----- 11 -- -- ------------------Liquid FCapaci Y - Agals. Privy: t.Distance ,from-nearest well...-.-.---__ .----.--_---.-- O istanccee 'frrom nearest building.. --------------------------------------- El - _.--.__.-_---.__ ! � ��, _ ---.------------- ❑ Distance.to nearest lot line .- -__---' Remodeling and/or repairing (describe):-.._--- /-. _--.--- _- -- __ _ "�""`"� �1 --- --- - --- --- - . ---------------------------------------------- - -� >` - -- -- - -- -- - -'---- ------- -------------- -------- ------ -----------------•------------------------ ------- �`--- -`--- - - ------------------------ =-----------------------------------_=----------- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin i.County ordinances, State laws, arfli rules and regulations of the San Joaquin Local Health District. Si ned}. ' I C ,t t ' --- '�' "�IILi�"TiC�T�Af�1K�S>✓F2�'iFCi�'�- -",- o I�rat By:.2 ISS:IUfipe'r 4 Hd 6r38a -- - - ---- ----------�-------------- ---(Title}.--------...:---- -------....._..------...-- (Plot plan, s owing size oPTot, location of system to lation to wells buildings, etc., can be placed on reverse side). 4 j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-.- DATE ._.-.-. ._ - ,. REVIEWED BY ------ ------ ---------------------------- -------------------------------- ----------------- DATE BUILDING PERMIT ISSUED........ --- - ---- - - - --- ---- A3 ----------------!--O-------!--6-----6 -- ---- TE Alterations and/or recommendations- ------ _.----Qrl ------------------ ------------------ ------------ --------= r FINAL INSPECTION BY:......all _ --..----------.-.-- - --------- Date-------------- '.� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockton,California r Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press r