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FOR OFFICE USE: <br /> --- ------ -- --- ------ APPLICATION FOR SANITATION PERMIT Permit No. .2-21 <br />------ ------- -- --------- ---- ----- --------------- (Complete•in Duplicate) <br /> This Permit Ex ices 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County <br /> Ordinance No. 5499. r <br /> JOB ADDRESS AND LOCATION,,/_,F7-----t/ .. 4_- - - - . --•-- 4 ---------------400i <br /> �+ `/ ----- <br /> Owner's Name--------- -,�---.---S,a/-4-0' /r------- Q__U-���/is .//----------- - -------- <br /> ----------- <br /> Address-- <br /> Phone <br /> Address - ------------ 45?# xv/�------------------•----••------------------ <br /> I , <br /> Contractor's Name------------- ------.... Phone._-... •----------------- <br /> - - -------------------------- ------- ------------------------------------- ---------------------------- <br /> Installation will serve: Residence I;j i partment'House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of)iytn9,unitV_ Number of bedrpg rjf�Nu ber of baths,_�„y of j�e _ Q ----&_kso--------------------- <br /> Contractor Address a2 O License No.PZ167, � eg '�r <br /> %+n n r Sana graver U Panay �odm U �,i y wdrn Lj $ LI u u r <br /> Previous Application Made: {If yes,date_._..._..-......_.. } No New Construction: Yes o ❑ FHA/VA: Yes ❑ No 21---t <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 /> i� No. of compartments---------- Size-------------------- -----------Liquid deP.fh--------- - -- --------Capacity...----------------.._. <br /> Disposal Fiele!`/ Distance from nearest well_____:__....._Distance from foundation----Z67------.Distance to nearest lot line____I.---� -- \ <br /> Number of lines-------- ----_ ength of each line-- a. �--�_-__......Width of trench.. ___________...______._ <br /> � �'® ----- <br /> Type of filter;material_ septh of ,filter material--- " Total length-- -- ------------------;-- <br /> rf: _N <br /> epage 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.-- --------- ----- ----------------Depth--------------------------------------------------Liquid Capacity--- ------------------------gals. <br /> Privy: Distance from nearest well................. ........_._.__-._-.._-_--_-_-Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line ------------------------ --.--- ----------- - ----------------- -------- --------- •. - <br /> • <br /> Remodeling and/or repairing (describe):----_.._ �_-_ iJ-�.. /�� .�__.______ ______--_-._ <br /> Lieu 6�'�/ � i/"'p � r! <br /> --------------- - .- ----------------------------------- <br /> y Ole ---- ---------------------------------------------------------------------------- <br /> -- -- ------ -- --- <br /> ---------- ------------ -------------------------------------------------------------------------------------------- --------------------------------------- -------------------------------------------------------------- <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 laws, and rules an regulations of the San Joaquin Local Health District. <br /> • <br /> (Signed)------------------- ----- -- - - ---- --- -------- -- �----{6 +dor Contractor) <br /> (Plo+ plan, showing siz of lot,.location of system i� a on to wells, buildings, etc., can .be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> # <br /> REVIEWEDBY---------------------------------- ---------- - - - -- ---- ---- - -.----------------------------------- ----- ------ DATE-------------------- ------- ------------------ <br /> BUILDING PERMIT ISSUED-------- -- ----------------------- ----- -------- ----- DATE------------------ ------------------------------------------ <br /> Alterations <br /> --------------- ------Alterations and/or recommendations: ---------------------- ---------------------- ------•-----------------------------------------------------------------•------•--------------------------- <br /> ------ --------------- ------------------------------------------------------------------- ---------------I------ ----------------- ----------- ---------- -----•--- --------"---------------------------------- <br /> ----------------------- ------- -- - -- --- --... - <br /> ------------------------------------------------ ...... ... . _. ._ <br /> I � <br /> f11 <br /> FINAL INSPECTI Y:.- - ------ -- Date <br /> r�--------- <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.lfaselton Ave- t 300 West Oak Street ~4 124 Sycamore Street 205 West 9th Street <br /> 5lackton,California ` -1 Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />