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FOR OFFICE USE: ------------------=----- ------ ------ _..--._------------ ------------- APPLICATION FOR SANITATION PERMIT Permit No. .crZ _ � --------- -- -- --- ----------- -- ------ e) . { . P p Date Issued ------------- -------------- - Date Issued om ete�en Duplicate) - This Permit Expires 1 Year From _ �� ; ZZ3 _�70.•,_ 0_5 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is madein compliance with County Ordinance No. 549. v _ 7°�:7 • C—O'Tr>46-E,: �� zoo 41 N q J9 ADDRESS AND LOCATION �`-(_- �. .. = ---------------- >�� err ��♦- E: PRS S t Owner's Name--------- ------f-�------ --2_3_ _11- 6-- ---------------------- ------- ------ --- - - Phone ------- ( Address--'. 7/..O......--- •------- --•------- - --------- -•---•--------------- Contractor's Name_.__ _._ . __�___. 3____v __ - Phone__ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ j__ Number of bedrooms _ ___ Number of baths __ ___ Lot size ----- f---4SQO___�_t_.`f`________-__ I Water Supply: Public system ❑ Community system ❑ Private P? 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_._ 4710.y- -. } No ❑ New Construction: Yes ❑ No [e-"FHA/VA: Yes ❑ No _. -TYPE-OF INSTALLATION AND-SPECIFICATIONS: .-- _ =. = - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we!#-----------------Distance from foundation--------------------Material ._.____..-----____-_---_-_____._._.---------- N L1 No. of compartments--------------------------Size--------------------------------Liquid depth--------- ------- ----.-..Capacity------ ---- ---- -•-- -------- Disposal Field: Distance from nearest well-_c'�_ -__Distance from foundation----1 0---._.-.Distance to nearest lot line----------------- [ Number of lines ----------Z...................Length of each line__-----,f �p-------.----Width of frenck-.-.-R--------------------------- Type of filter material __a/?A5? -------Depth of filter material-----1, ------------Total length_____/-Off__------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line..._______.___.._ ❑ Number of pits--- .---_--------__--Lining material.................... Size: Diameter---------.-------------Depth------_--------------------_._-_. { 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 ...__-__.___--_------_ ___-.--._--.._.Distance to nearest lot line-----------------------------------------------•----------------------------------------- --------------------------------------------- Remodeling -------------------------------- -Remodeling and/or repairing (describe)___________________ f - -------------------------------------------------------------•------------------------------•-----•----------------•--------------------------- ----------------------------------------------- --------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,'and rules and regulations of the San Joaquin Local Health District. • h (Signed) . .......... and/or Con+racfio ri.r�.,r .. �-s-'!�•�.wr:.s�,rr .. .ti F - - _ r _j t �- wne By---------------------------------- ------- ------------- ------- ------------------ -------- --------- ------------- .....Title)------ ---- ----- -- ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --- - [- -`--R_' V-.------------- --------------------------------------------------- DATE.-.--- - REVIEWEDBY--------------:------ --------------------- ------ - - ------- -------- --------ii ----•- ------------------------------ DATE BUILDING PERMIT ISSUED-------- ------------------------ - ------ ---------- ----------- ----------------- ................ DATE.----------------------------- Alterations and/or recommendations:.................._...............------------------------------------- --------- -------- - -----••----------------------------------------------------- -------------------------------- • ------------------•----------- ........ ......................... -- ----------- -- ------ •-------------- ---------------------------------•-- ---------------------------------------------------------------------------------------------- -------•-------------------------- -------------------------------- ------ -- ------ ---- ---------------- ----- --.----- -----------------------------------------------------------------• ---- --------- --- ------ --- - +� r f FINAL INSPECT] BY:.-- Date------------------- ._...!-.I`--U .--------•------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Sheet 124 Sycamore street 205 West 91h Street Slockton,California Lodi, California Manteca,California Tracy, California t E.H.9 2M 1.67 Vanguard Press