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FOR OFFICE USE: <br /> i ---------------------------------------------------- q- <br /> ----------------------------------------------------iM,-.. APPLICATION FOR SANITATION PERMIT Permit No. . -P_._=_--- .. <br /> IM (Complete-in Duplicate) <br /> .-.. --_..__ _.. This permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made i�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 /> Q 1 <br /> JOB ADDRESS AND LOCATION---- / .Q.� �. ..�.Y --------i v--------------M _N-f EOA--------------- <br /> Owner's Name---- - -f� -�--------c-oA -- ---.- Phone_F23- 3 9Z�- <br /> Address i . 5 '1!------------f 5.Q-W-----. 1/! . .f�?t r__t'h -r�- --------------- <br /> Contractor s Name }I�-.---._...4,r__l /r--`�------------------ ------• ---=---=---------------------- ---------------- Phone-993-6-STY. <br /> f.. <br /> I <br /> it Installation will serve: Residil ence ['g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> 4 Number of living units: _ -- Number of bedrooms 2_—Number of baths_l---.- Lot size ---AC-K.F—A6-LE---------------------- <br /> r Water Supply: Public system ❑ Community system Ig 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 0? New Construction: Yes ❑ No �A/VA: Yes ❑ No <br /> TYPE OF INSTALLATIONAND SPECIFICATIONS: <br /> (No septic tank or cess� po:ol permitted if public sewer is available within 200 feet.) <br /> Septic.Tank: DistaA <br /> from nearest well-----------------Distance from foundation----.-.--._--- ---Material .------------------------------------------- <br /> No. of --. - <br /> ❑ Nlom Partments..._----------------------Size------..-.-.. ._ -----------Liquid depth-- ------ ------ --------Capacity----------------------- <br /> Disposal Field: Distancehrom nearest well..s0-----Distance from foundation---/.0----------Distance to nearest lot line----6----_-- <br /> � Number''of lines:, „t 1_-y._. _.__._._._._--Length of each line-- .� d_ -_-- Width of trench.----Z------------------- ---- � <br /> Type of--titer material----l2&d<---Depth of filter material.--_-,:� ------------Total length--.. o d-------------------------- \�b <br /> Seepage Pit: Distance!to nearest wel!......................Distance from foundation--------------------Distance to nearest lot line_---------------- `�1 <br /> ❑ Number'of pits.-- ------------ Lining material---------------------- Size: Diameter-----------------------Dept h...... <br /> -------------- <br /> ------------- <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 /> Remodeling and/or repairing (describe=,­--------------- -------------- ----------------•-------------------------------------------•------------------------------•-------- ---------------- <br /> ------------------------•--- -- ----------------------------------------------------•--------------------------------------------•------------------------------------------ <br /> -------------------------------------- <br /> ---------- ----------------- --------------------II-------------- --------------------------------------------------- --------------------------------------------------------------- --------------------------------------- <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 /> (Signed) �� ----------- - '----- - ------ - ------- --------------- --------(Owner and/or Contractor) <br /> ------- ` ---- -- <br /> IN <br />��(Plot-plan,-showing-size.of-lot._location-of_system-in_relation tow is buildings,_etc.,,can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ryi <br /> APPLICATION ACCEPTED $Y � �0�- - DATE-- ---- '" l <br /> REVIEWEDBY----------------------- --------------------- ------------ ­------------- -I-------------------------------------- ------ DATE <br /> ­ <br /> BUILDING PERMIT ISSUED-0- -- - ----------------------------------------------------------------------------------- DATE - <br /> Alterations and/or recommendations--------------- - - -- - -..-------- ----------------------------------------------------------------------••-------------•-•----------•-------------------- <br /> ------------------------------------------1l <br /> ----------------------- ----------- ------------ -- ------------------- ----------- -------------•---------------------- ---------- --------------------------------------- ------- ---------------------------------- <br /> --------------------- -- -- --- - ---- - ------------ ---------- ---------------------------------- - --------- -- . <br /> ------------ ------------ -------- �M .` . ....---....--- --- ---- - --- - --- -----_- ...------ --------- ------.......... .-------------+ _ <br /> FINAL INS -- - ------- Date 1.. r ----------------------4-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Slocklon,California Lod',, California Manteca,California <br /> . Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press..,_ <br /> I <br />