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FOR OFFICE USE: ------ 02a r 0 4 APPLICATION FOR SANITATION PERMIT Permit No. ...................J... ---------------------------- ----------------------- --- (Complete-in'Duplitafe)- 6 This Permit Ex `fres 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t eswork herein scribed. This application is made in compliance with Count Ordinance No. 544. Its 130 rJr/14, ID& 'JOB DRESS AND- LOC ON... �. L- X �"t � ►------------- - ---------- --- ------ ` � Owner's Name J-IlJt.d 1.C. .-- ----------- -------------------------------------------- Address------- ----------------------Address------- +,��r1 ?``� " - `- -------------------- - --------------- ------------------------------------------ --- - Contractor's Name, J,�.- JA4-&kC'A_------ ' " - ---------- Installation will serve: Residence Apartm House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other -❑l Number of living units: ---- Number of bedrooms Number ko the & of size Water Supply: Public system E] Community syste t❑ Private Depth to Water Table __.----- ft. Character of soil to a depth of 3 feet: Sand ❑ Grave ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 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.) . I Se is Ten Distance from nfarest well-----------------'FDistance from foundation-----__--_____._-.Material-___--.-....---.--.__--______-__.______--.-. n No. of compartments----- -t-----------------Size--------------------------------Liquid dept------------------------Capacity----------- ----- o VI d , Distance from n crest wel -..._;Distance from foundatio _00______.Distance to nearest lot line -_____ Number of lines_ ___. Length of each line._._-- --��.__.Width.o`trench- f "0� Type of filter materia _Depth of filter�material___.� .______..__Total--ierigth__..___.____________ © ---- Seepa ePit: Distance to near well- 0�_ _.____Distant fro foundation___ �Distance,to nearest lot line_Napo -------- Number .-_. t i = �. n 11* Number of pifs._ --------------Lining material-d- --- -=-------Size: Diameter_.. t_bep+h.Q1 --------------------- Cesspool:' Distance from nearest well-----------------Distance frfoundation--------------------Lining m ferial___...-_------_---...._.___.____.__ I El Size: Diameter----- ----- -------------------------Depth-------- ----- ----- --------------------- ------Liquid Capacity gals. if Privy: r`. Dis+ante from nearest well-------------- __._----___._-------.-.._Distance from nearest building.-..-...-_-----------------._-___._..__ Distanceto nearest lot line------ ------------------ --------------------- ----------------- ---------------------------------------------------------- ------- Remodeling and/or repairing (describe)--------- -------------- ------------------- ------------ --- --------------------- ---- -------- -------------------------------------------- t ail � - --- - -- -- ----- --- -- -- --- - -- - ------------------- ------------------------------------ -------------------------------------------- - -- - ---=----- -------------------- -------------------------------------- I - O hereby certify that I have prepared this application and that the work will- a done in accordance with San Joaquin County ordinances, St laws nd ruleand regulations of the San Joaquin LacaI ealth'District. Contractor {Signed - - --------- -------- `1F' br f 1 BY = ---._._ It e--------- ------------ ----- --------------.._...--------- (Plot plan, showing size of lot, location=of system,irr,relatio o wells, build'tngS` tc., can be placed on reverse side). wi yFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -- ---------- - ------ ---e�-��--- ------ DATE------e�4 2---------- ----------------- REVIEWEDBY------------------- ` - ------------------------------- ---------- DATE------------ ---------- ------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------=-----t---- -----------•---------- ------- DATIE-------------------------------------- ------ -- ---------- Alterations and/or recommendations:----- 1 ! Com` ` ---- s'Y�--------- 0 , ----------- --------------------------------------------------- -------- ------------------------------- ------------------------------------ ----------------------------------------------------------------------------- ------- --------------------------------------- ------------------------------ - ------------- ------- --------------- ------ ----- ------------- ------ ------------------ - ---------- ----------------- ---- ------ --------- -------------- - ------------------------------------------------------------------------- - - ---------------------------------------- --------- I j L - Date. fi L ------------------------- FINAL INSPECTION BY---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California F.RCCL