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FOR OFFICE USE: <br /> 3�- .� •. <br />. .-._-------- -----------------_--------- ...._.__.__ APPLICATION FOR SANITATION PERMIT`' Permit No. <br /> (Complete-in Duplicate) <br /> . ----- This Permit Expires 1 Year From Date Issued Date Issued <br /> C' Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. <br /> This application is made in compliance with County -Ordinance No. 549 <br /> . . _____ <br /> �j -1;:_ ` -------------------------------------- --------•---------------------------------------- <br /> JOB ADDRESS AND LOCATION <br /> Owner's Name-,/ �'L *.O?-------------- ----------- ----- --........---------------------------- ---- Phone------------------------------------ <br /> ddress ----------- 4 ---- - ------------- " <br /> Contractor's Name..._ ... = <br /> --- `�~ ----- ---------------------------- --- Phone------ ------------ <br /> Installation will serve: Residence [ Apartment Mouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/---- Number of bedrooms __3-.. Number of baths _ ._ Lot size ----- --- -------- -------- -------------- -_-_ <br /> Water Supply: aPublic system:❑ Comminity system ❑ Private Depth to Water Table _46 ft <br /> 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 K- New Construction: Yes ❑ No [��FHA/VA: Yes ❑ No 8--� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: _ Distance from nearest well-----------------Distance from foundation------------------- Material ------------------------------------ <br /> --_-_------. <br /> " No. of compartments Size Liquid depth- Capacity -------------- <br /> Disposal <br /> p *,1 <br /> Dis osal Re Distance'from nearest well._41a_--_____Distance from foundation .t}-_..-------.Distance to nearest lot line-- ............ �* <br /> � d Number of lines`------2-----------------------Length "of each line-- -----------------------Width of french 1( ------------------ <br /> Type <br /> --- ------_------Type of filter material_'F_0Lk.........Depth of filter material._-, .*............Total length--- .e"00 .______________._ <br />; <br /> Seepage Pit: Distance to nearest well-----------------_-~_Distance from foundation................... Distance to nearest lot line__------_...----- <br /> ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter-----------------------Dept h--------------------------------- <br /> Cesspool: Distance from nearest well ------ ---------Distance from foundation.-............... ..Lining material---------------------------------- <br /> ❑ Size: Diameter- 1 --------- ----- ----------------Depth- -------------------------------- ----------------Liquid Capacity---------- -- --- ---------gals. <br /> I Privy: Distance from nearest well ...__-_._._._____...._Distance from nearest bu;lding------------------------------ __-- -. <br />€ ❑ Distance to nearest Ipt line --------------------- <br /> ERemodeling and/or repairing (describe)--------------- -------- ----------------- ---------------------------------------•----------- ----------------------- ------------------------- ----- <br /> -•-------- ------------------------------------ ------------•---- ----------------------------------------- ------- -------------------------- ---------------------------------------- - ------------- <br /> --------------------- <br /> ---------- ------------------------------------------------------------- -----------•------------------------------------------ ---------------------------------------•--------- ---------------------------------------------------- <br /> I <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 law , and rules and regulations of the San Joaquin Local Health District: <br /> --------- - .-------- = <br /> (Signed)---------- -- ---r ' --------------- - - ----------- --------- --------------------------(Owner and/or Contractor ;...� <br /> BY: •------------------- ---------- -------------------- - <br /> --------(Title)---------- ------ -- - -- ---- -------- -- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 1 <br /> i # FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--"----- c --------------------------------------- ------ DATE_ ----1--4 =G <br /> REVIEWEDBY---------------------- - "---- --- ........ .- ------------------------------------____1 - --------------------------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -- ------ DATE-----.---------------- ----- ------ -------- <br /> Alterations and/or recommendations% ..-"---------------- ---- -------------------------------------------------------------------- -----------------•------------------- <br /> ------------------------------------------------------------ ------------------------------- <br /> t <br /> i <br /> - ------------------------- <br /> FINAL INSPECTION BY:.-..._.- ._ <br /> L�.: . ---------- Date.......... ...1--�--�-G-�--- - --------- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slocklon,California Lodi. California Manteca,California Tracy, California <br /> E,H.9 2M I-67- Vanguard Press <br />