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FOR OFFICE USE: -- --------------------- ------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. -kzJ� � ------ -------------------------------- ----- - -------------- (Complete in Duplicate) Date Issued ------------ - --- --- -----------------_--.--.----_--- This Permit Expires 1 Year From Date Issued IF 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. + � - N 0 K • Cox - ,---------•- JOB ADDRESS AND OCATION....- -.- -_- J---.- / ---f ----1-------- 221 - ----------------------- --- -- ----------------------------- -------- Phone-------- ••------------------------- Owner's Name-- --- - ---`--••-� --------------------------•------------ I -- a. r ✓---•----------- z-------------------------------------------------------------------- ------------ ------------------------------------------- Address- -.. Contractor s Name J'---- ------ Phone = Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E Number of living units: --/-- Number of bedrooms -Y-- Number of baths - Lot size --`_ .0 =------------------'----------- Water Supply: Public system ❑ Community system ❑ Private [8"'Depth to Water Table If. �: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ® New Construction: Yes ❑ No FHA/VA: Yes :f TYPE OF INSTALLATION AND SPECIFICATIONS: j� (No septic tank or cesspool permitted if public.sewer is available within 200 feet.)l Septic Tank: Distance from nearest we -- �-----Distanc/e from �oundatFon_--1 ---.----Matlna4-. _ - _------- No, of compartments-- -----_- e�-C .Liquid depth--` ...----. p ty -_--- Siz _ -�`�,-- ---------Ca aci Disposal ' ld: Distance from nearest well__ P.l-._._.Distance from foundation--i---------Distance to nearest lot line.5±r--------_ L ` - -- g / � [ Number of Imes----__-_ ,_ _ -_-..--,_��-{{- Length of each line_- .? --- - Width of trench-----.-._- _.------- Type of filter material_ Y� Depth of filter.material-_/t_' ----_____Total length ........... Seepage Pit: Distance to nearest well___/401 ----_-Distance f m fo ndation_-__'�-----_-_--.Dist rice to nearest lot e--�------- Number of pits.- material-/ -.Size: Diameter— .......Depth- .-----'---.--- ---. Cesspool: Distance from nearest well------------ --Distance from foundation---------------------Lining material--------..-.-___------:-q------------ ❑ Size: Diameter----- ------------ -- -----------------Dept h------------------ ---------------------------------Liquid Capacity---------------------------_�-----gals. Privy: Distance from nearest well------------------------------------------------Distance ,from nearest building------------------------------------.___.__ ❑ Distance to-nearest lot line --- ------------- --------------------------------- ----------- �j n -----------------I------------ Remodeling and/or repairing (describe):-----.--.. OV i/.�+ � -- - •- - ` �� ---------•--•-----•----------------------------------------------•-_---_------__-------.--_---•-_---------.--.----------------------------.-_-_------------_--- -- _----___--------.--------_-_-___------ 1-_--__---. 1. iI ------------------------------------r-.-----------_---------------'--------------••-•-.--_---•---------_--.-----_-_-----•_••-----_------._-_-_-_--_---_----•------_- _, ---------..---_----__-------------- .-__-.-_-- at r s • II I hereby certify that I have prepared this application and that the work will be done in accordance with San JoaquiniCounty ordinances, State laws, a dfr �nid'—regul ions of the`San Joaquin Local Health District. l y (Signed)------------ - - - -----�-- -- --- ------------ -� ----------------- ------------ ------------- Contractor) � -, -- f at or (Plot plan, showing-Si---------------------------•---------------------- -- - •- -----------{Title) '�` 'i-- B Sze of lot, location of syste n e ation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- --------------------------- - - -------- DATE------------f7- --- ----��----.-------' REVIEWED BY -T ---- ------ ----- --- ---- ----------------- ---- DATE BUILDING PERMIT ISSUEM_----------------------------------------------------------- DATE---------_---- � ------------- Alteration'rarid/or recommendations: •---------------------------- --------------------- ---• --------------------------------------------•--------•------- ------------------------- ------------- t ,, -------------------------------------- ----------- --------------- c ------------- --�------------- -------------------------------- ------------------------------ ---------------- ------------------------------ -- ............................................... - ----- - II - �.� o ---------- FINAL ENSPECTION''BY:-------- -- -------------------- ------ --------------- - Date ----=----- ------------- SAN JOAi7UIN LOCAL HEALTH DISTRICT, k . . INi 1601 E.kacellon Ave. 300 West Onk,Streel 24 Sycamore Street �. 205 West 9th Street I� 07 A Slocktan,California Lodi,California Manteca,California Tracy,California iI CS 9 REVISEP 5-59 3M 3-'63 F.P.CQ• } ��