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rvK UrflLt USt: -- ------------- --_------ --------------------------------------- --------_ _ _ __..-____..__ __ __._____-.___.__. APPLICATION FOR. SANITATION PERMIT Permit No. __Sf - (Complete in Duplicate) -- --- This Permit Expires 1 Year from Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de 0 ed. This application is made in compliance with County Ordinance No. 5497 JOB ADDRESS AND LOCATION._ m ---------- ,/mss .� Owner's Name------------- -- - --- Phone..---------•---- Address----------------- f` - ------------------ I Contractor's Name___.___ .-.,/ i`1; s --,_- --_-_-__ �-= <.�- t -4�''".��' /- -- � -'-'---------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court"E'l..f,Motel ❑ Other ❑ Number of living units: __- Number of bedrooms __ '___ Number of baths' _ Lot size:_��?- Water Supply: Public system ❑ Community system ❑ Private 29 Depth to Water Table ---------ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam' Clay ❑ Adobe❑ Hardpan [] Previous Application Made: {If yes,date------------------- No U,- New Construction: Yes o ❑ FHA/VA: Yes ❑ No gj� s TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if'public sewer is available within 200 feet.) Septic Tank: Distance from nearest weft___ p...Distance from foundation_+/ fr__------_-Material_._l_1 p - � I No. o tom artmeri-ts. �_ � _�_.J` L'quid depth___ __-_.�__...____-__Ca acitY� f r �. ' Disposal Field: Distance from neares well.._.__- -___Distance from faun anon.-/O--___._._Distance to nearest lot line----- - Number of Imss_.- .__-- --` -------Length of each lir / Q-----�fid_Wid'th' of trehch:' i ''�`"----.-----'- Type of filter material_oO/,,j�___Depth of filter material- _/ ------ _----Total length_-___._ Seepage Pit: Distance to nearest'well..,l� ----------Distance frpfn foundation---A��' _ . ._,-._______. fst nce to nearest lot ne________________ 19-11, Number of pits.. . Lining material__S'. + '.__-Size. Diaterl _ �_`6eptnli _a `_� I Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------_----______-.---___.---_-_-__. ❑ Size: Diameter---- ----------- - ----------Depth------ ------------------- Liquid Capacity gals. Privy: Distance"from'nearest well_ ---- ..:.:........ ---------------Distance from nearest building ❑ Distance to nearest lot line-----'--------------------'---- '----------------------------------------------------------------------------------------------------------- Remodeling' and/or repairing (describe):____.__, -----_---v S � j -------• ------------------- ' - / f , 7 ------- -------------------------------------------------------i---------------------------•------------------------------------------------------------------------------------- -----------F`---------------------±-----------------'- I.hereby certify that I have prepared this application and that the work will be done in accordance with Sart Joaquin County ordinances, State s, and rules and regulations of t n Joaquin Local Health District, .:. ,-d> [Signed)------------ - ---------- -------- n and/or Contractor) $Y= �--------- _;em ` --= (Title) _ �----------- (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.......... ....... --- - ._ ----- -------------------------------- DATE- REVIEWED REVIEWED BY. -- - . 'DAE---'r'` ------- - -- - --- BUILDING PERMIT ISSUED------------- e,/ / - ------ DA•TE.--- ''= �� °'- ---Alterations and/or recommendation - -----------•-----------------------------------•------ -------------- ---------------------------------------------------------'----------------------- -------------------- ------------------ -------------------- ---- ----------------------- - -------------------------------------------------------- FINAL INSPECTION BY:a y± --- ---- ---- Date._. �G' --------- - - -- F '-'---------'----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Stocklon,California Lodi, California Manteca,California Tracy,California r.A.CO. h