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FOR''OFFICE USE: ---------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _ ____________ ______ (Complefe-in Duplicate) Date Issued . .. -- -------------------------------- isermrt Expires 1 Year From Date Issued 025—(5�--4� Application is hereby made to the San Joaquin Local Health District-for a permit-fg permit-fconstruct and install the ork her in described. This application is made in compliance with County Ordinance No.-549. [ r�2 JOB ADDRESS AND LOCATION....._ . . d- . ------------ __ .._ F �.G• ;Jf•A- - r //�yyr Owner's Name C +O 7" :._ .. Phan Q_-Z-7._'-1�.. : 1 Address-- _ -- ----- -------- - -------- ----------•------------------------------- Of Contractor's Name f Phone_-_-"_J t � Installation will serve: Residence partmen} House ❑- 'C m ercial`�❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: --/-- Number of bedrooms`.—'_ Number of baths _-Lot size _ _- _--.._� Water Supply: Public system ❑ Community system•[) `Private ❑' Depth t�Iavy "er Table ft Character of soil to a depth of 3 feet- Sand I] Gravel ❑ Sancly.Loam. oam,❑ Clay ❑ Adobes❑ HardpanE]' t " , i , Previous Application Made: (If yes,date.......... ------- ] No E NewAC'ohsfruction:-Yes ❑ No ❑,. FHA/VA Yes ❑ No ❑I TYPE OFF INSTALLATION -AND SPECIFICATIONS-. septic tank or cesspool permitted if public`sewer t availabEe wrthrn 200feetSe �No Distance from nearest well-----..--i----Distance from foundation ..__ - .__--__Material _____ ______________________ if i a� °�No'•of com artments. ............. -'':.Size._.._____.-.-_-_. _ _ P Liquid depth----- - --- -------Capacity �' Distance from foundation .Distance to nearest lot line 7l D�i osal field• Distance from nearest well� .� .I�iCl--�� Number of lines.N- ' Length of each line__'_,/44___/-- .Width of trench.-_�� ---e----n------.-.--�-w -- - --- - /�QT e of filter materiahDepth of filter material--------1 ......Total length-.-.--- ...... ------------ I Seepage Pit: Diance to nearest well�--_:-----_ ..._Distance from fou dat�on--------------------Distance ---"-•-- i to nearest ft sp❑ s ---._.__.Lining material----- aterial------ ----- -� Size. Diameter- ----------- -- ---Delth-------------------------- Cesspool; ----Cesspool; Dstance from nearest well _ ..- -----Distance.fromfou'n.dation _ . ..... ..Lining materia ........___--__....__-.__, -- -------------------Size: Diameter- -------- ---------A -- Depth" -- --Li uid Ca acitY [= -g- -aa Privy: Distance from nearest well -------------------- -..__.-Distance � � t I from nearest building____.____.._.._---._-.--------- I ❑ Distance to nearest lot line ---- " F Remodelin and/or repairing. describe ! I! g P 9, ( ) 4 --- - - ----------------•----------•-----------------------"-- ---------------------.---.Y;..____ __ .._....___. __ - I D ------------------------------------------------------------------------- - 1 - I_ --------------------------•------ ----------------------------------- ----------------------------------------------- --------------------------- --------------------- ----------- ----------- ------ ------------ --- I hereby certify that I have prepared this application and that the- work will be done in accordancekwith San Joaquin County ` ordinances, State laws, and rules and re ulations of the San Joa tiin Local H istrict. t 9 � .I. ti i (Signed) - - t- I f.�'� f/L? ' J 1.f/� � Contractor( . ... .,.,...,__.-: -e-- ,--- - - rte„_,;. -- .............. --- - -�- (Plot plan, showing size of lot, location of system in relation to ells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' ! APPLICATION ACCEPTED BY.._. .-.----I---------------------------------------- DATE--r~ _�'4-7 ---------------- REVIEWEDBY-------------------------------- ---------- --------'---------__---------------- DATE------------------- BUILDiNG PERMIT ISSUED.- ---------------------------- DA-TE----- ------------ r Alterations and/or recommendations:---------- ---------- -------- -------- -------------------- ------•-- ----•- ------------------- ------------------•-------------' t I --------------- •-• - ---------------------------- --------•- ------------- -- ---------------------------------------------------------- ----------- ----------------------------- ---------------------- ----------------------- ----------------------------------------- ----------------------------------------------------- ----------------------------- ---- ----- ---- -................................................................._.__._..._.___.__._.R__._-___....__.----.-.-_________._____-_._____-____...--_-..___.--..._.-_-___-._-_-_. ._.__.. ..___. -------- -----------------------------------------------------------'--------...._._. -._._.-----------------------'----- ------ -------------_-_--------------------------------------.... .._. ...-------------...----.----.. r ii FINAL INSPECTION BY:_-r1!::A; . _ - ------ SAN JOAQUIN LOCAL.HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 20.5 West 9th Street r 5lockton,California Lodi. California Mantecar California Tracy,California E.H.9 2M 1.67 Vanguard Press i