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FOR OFFICE USE: <br /> '7,A34-1---------- � <br /> ----------------------- ------------- APPLICATION FQR SANITATION PERMIT Permit <br /> ------ - --- - ------------------------------ --------- (Complete•in Duplicate) Date Issued -_1, z--3.______�� <br /> -- This Permit Expires 1 Year From Date Issued _ ---- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND OCATION_------ --- -- .•- -ror---------------- <br /> - ---•----•---------------------------------------------- <br /> Owner's Name---- -.-- "J.!-�f`r-,P1072-------------------------------- ------ --- ----.- Phone------------------------------------ <br /> Address......_ -l??.�.-.___----. - _ <br /> - --------------------- -- - - ------------ <br /> Contractor's Name -. - _..-. Phone----- --------------------------- <br /> Installation will serve: Residence} Apartment House E] Commercial F] Trailer Court E] Motel E] Other <br /> Number of living units: v"_.. Number of bedrooms 3-1.- Number of baths,l--- Lot size -- ------- ------------------------ <br /> Water Supply: Public system P000Commtdnity system ❑ Private ❑ Depth to Water Table ------_ 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 R2-- New Construction: Yes ❑ No ®—FHA/VA: Yes ❑ No ®-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sematic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ------------------------_---___.._-------._. <br /> �K�A✓� �� No. of compartments------------ --- - ----------------------Liquid depth--------- ------- ------- Capacity----- ----------------- <br /> Disposal F.ield� Distance from nearest " Dista ce from foundation---. _._..Distance to nearest lot line____-�-.-. <br /> Number of lines -.--__ -----�_--- _ --- -Leath of each line-- JO ----------------Width of trench.-A-�------------------- -- <br /> Type of filter material_/�� f�epth of filter material-- _�' ... otal length___ - ° -'�---.-_ <br /> Seepage-Pit: Distance to n rest we _._---_ -------------Distance from foundation----_-----._-----.- Distance to nearest lot line----------------- <br /> Number ------- Size: Diameter---------------- - ---Depth--- ----------------------------- <br /> Cesspool: <br /> ----- ---------------- <br /> Number of pits._- -. -� ---------Lining material_____________ -. <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 /> T r <br /> Remodeling and/or repairing-(describe}:_-__-__e6&j-C®..'40" ------- <br /> -------------- <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 y <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) d0w+�ler-Contractor) <br /> By------------------------ ------------------------------------------ ... ------ {Title)------- <br /> (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------- ----------------- - DATE - "i'- <br /> ------------- <br /> REVIEWEDBY------------------------ - ----------------------------------------------------------------------------------------------- DATE----- <br /> BUILDING PERMITISSUED-------- ---------------------------------------------------------------------------------------- DATE. <br /> Alterations and/or recommendations:------------- - ---- ------------------------------------------ ------------------------------------ ------------- <br /> ------------ --------------- ------------------------------- ------ --------------•---•---- ---------------- --------------------------------- <br /> ------------- --- .................... ----------------- -------- ----- --- - -------------------------------------- ---- ---I--------------- ------------------- --------- -- ----------- - --------- ----------------- <br /> FINAL INSPECTION BY--------------4` --------------------------------- Date--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Streei, <br /> Slocklon,California Lodi. California Manteca, California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />