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FOR OFFICE USE: <br />.......... . ......... 1-1 ........... <br />APPLICATION FbR SANITATION PERMIT Permit No. ...... f <br />......................... I ......... . I ....... <br />........... 17 -Az- -3•3 <br />........................ . "­ ....... (Complete in Duplicate) Date Issued <br />........ - ............ This Permit Expires I 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 ciescrIbed. <br />Thin application is made in. compliance with County Ordinance,No. 54'9. <br />' <br />JOB ADDRESS AND <br />VOW <br />Owner's Name,­_iL ..... ......... ... .................... Pho <br />s 3 <br />AddresL ....... ...... <br />Contractor's Narrra..__ ... . ...... <br />installation will serve:. 4 Residence Apartment House ❑ Commercial ❑ Trailer Court C] Motel [I Other ❑ <br />Number of living Number of bedrooms. Number ofl'!afhs 5a Lot size - ................ ------- .... . ... <br />Wafer Supply: Publi� system 0 Community system [I Private [E Depth" to 'Water Table Z.e ft. <br />I Adobe Hardpan Character of soil to a depth of 3 feet: Sand 0 Gravel [] Sandy Loamjjj Clay Loam C1 .,Clay r Q19 <br />Previous Application Made. (If yes, date ....... ) No New Construction: Yes f] No [] FHA/VA-. Yes E] No P-, <br />TYPE OF INSTALLATION AND SPECIFICATIONS - <br />(No septic tank or cesspool pertnitted if public sewer is available withiin 200 filoi) <br />Septic Tank: Distance from nearest vaell. Distance from _Maferiai ... ...... .................... <br />.1 ___ ---- L ........ Liquid dep*_...... . ......... ___Capdc4ty____ <br />NO. 0. ...... <br />Disposal id: Distance from nearest well-l'.177A ....Distance: from Distance to nearest lot tine. <br />...... <br />F-11, Number of lines ...... ...... - __Length of each line...../ - W;dt'h of french. 34 .. <br />01 � <br />Type of filter materia ....____Depth of filter. )mf,-rial .... . ...........Total Total length <br />Seepage Pit: I Distance to nearest well...., .........Distance from foundation.......:__ ,_.Distance to nearest lot line.... <br />........ . .... <br />71, j,"Number of pits........._ ,.......... Lining material,. ------ Depth- ............ <br />/Iesspocil- Disfance £rash nearest well..... from foundation_..'.... ... material. <br />0 Size. Diameter,.__...........De; th ...... ................................. Liqu* sd�,Capacify- ........ ____ .. <br />... --gal <br />. <br />. . ...... Dieance from nearest ....... <br />Privy: Distance from nearest well........_..._...,_.... <br />Distance to nearest lot linc-­­ .. ......... .................. ........... <br />Remodeling and/or re`pa7ring <br />........... _1 ............... _ ........ ------ ...... ............. . ........ <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 and regulations of the San Joaquin Local Health District. <br />Signed)_r Contrac-for) <br />- -- - ------ <br />(_ ..... <br />(Plot plan, showing six, of tot, location of system in relation 0 wells, buildings, eic., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />.... <br />APPLICATION ACCEPTED BY., �,� ............... DATE.- <br />.................. <br />REVIEWED BY .. -._ _...- <br />E .... DAT ........... ..................... <br />---- .... . __ <br />BUILDING PERMIT ISSUED... . ... ....... ........ DATE -- - -------- <br />Alterations and/or recommendafioris: .. ...... ... ....... __ ...... ­_­­ .. . .... .... . . . ...... ........ - — ------ . ....... ... <br />11-1 ........ . . .... . ........ .............. <br />............ ­­­­ ......... 1 .......... __ ............... __ ........ ......... <br />................... ....... ............. .... .. ... .......... ­_ ............. <br />I ...... . . ..... .. ......... ­­ ...... ......... . .. . ..... . ... <br />. . ... . ............ ......... <br />-_--1 . ...... . ............. ;­­­ ...... . . .......... ­ ...... ­­­­, ......... .... ............... ­­ ............. ....... <br />FINAL I INSPECTION ', BY:- <br />........................ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />140 t E. Hax#lton Av-*. 300 Woo Ook street 124 Sycamore Street 205 West street <br />stackto", California Lod;, California Manteca, California Trary, Colifomm <br />Vs So pcvlaro iM-rip am Z -6m pl,Mcc, <br />