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FOR OFFICE USE: --- --------------- - I 7 } ----------------------------- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ✓2� r .5� ---------------------------- -- ------------- (Complete-in Duplicate) ----.----- - ... TF1ls Permit Expr Expires 1 Year„From Date Issued Date issued __ _-_�� Application is hereby made to the San Joaquin Local Health District fora permit to constr ci1't`and jet ali the�ork here n �escribed. This application is made 1n compliance with County Ordinance No.J14 3 �` / .Gee ,13,5_0-0 ,`7► --JOB ADDRESS AND LO ATIONC .. r z .� , r p r Owner's Name ------- ------ Phone... [52. y Address.------------------------ ----------- - - ° - ----- -- QxC /� Contractor's Name- P-A_.- _. _5 - --------- --------w3 ---------- Phone_41!i6_fee,7-- i Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __}.___ Number of bedrooms -'Y Number of baths t------ Lot size _-��-. �(------------- �� Water Supply: Public system ❑ Community system ❑ Private'K Depth to Water Table 7.5 ft Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam X Clay 9 Adobe, Hardpan El Previous Application Made: (If yes,date......_----------- ) No New Construction: Yes E] No X 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 well----- -----------Distance from foundation--------------------Material E]&Ls 'NG No. of compartments----------- -------------Size-------------=-----• -------.-..Liquid depth--------- ------- ----.-- Capacity-------------------------- Disposal Field: Distance from nearestwell-.�,� ._....Distance from foundation_/Q__ ---------Distance to nearest lot line-_/O-do (� Number of line e.-Cr_ - Length of each line__4.i9—---------------Width of trench---2-.4-!-.( ---------- Type of filter material_-.I --------Depth of filter material--.`__1%----.-------Total length- --4Q--' -- -------------------- r r � � Seepage Pit; Distance to nearest well_ ov_ Distance rom f undation._l _________..Distance to nearest lot line-,/47- .......... - ._.. Number of prts__Q�S.L_[1.�.__Lining material-- _-` C_-_- Size: Diameter._.__3_3_r'r------Depth---- Distance from nearest well ----------------Distance from foundation._-- ------ _.Lining material-...--_----_...._-__.__----_-_-------. ❑ Size: Diameter- -- ------ - ----- ----------------Depth---- ----------- ----- - -------------....Liquid Capacity ga)s. Privy: Distance from nearest well..----------------- ------ ------ --_----------Distance from nearest building_.-_-.-__--__-_-_-__------___.__.. . ` ❑ Distance to nearest lot line --------- ----- - ------ ----------------------- Remodeling and/or repairing {describe):_..-_r -�Q- -L---.-.- --�_J )--[�/-� ---------------- - - ----------- -------------- ------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and s and regulatio of the San Joaquincal Health District. t + (Signed) - - (Owner and/or Contractor) By:------------------- - (Title) ------. --... -- ------- By: - ---- - (Plot pian, showing size lot, location of system in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - ---- ---- - ----------- -------------------- -------------------- DATE L � REVIEWEDBY ----------------------------- ---------- -----------------•-------------------------------- DATE------ - - ------------------------------------------------- i BUILDING PERMIT ISSUED---------------- ----------------------------------------------------------------------------------- DATE--------- -------------------------------- Alterations and/or recommendations---- - - --- ------------------------ ------ ----- l - --------- -------------- ----------------------------- - ----- ------------ --------------------------------- - ----- - --------- ------------------------------- ------------------------- ----- --------• . . ----------------------- -------- -------------- ---------------- ------ - ----------- FINAL INSPECTION BY: ------Y (-�k . ........ Date---------------- SAN - ------------•SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Slocklon,California Lodi, California Montecar California Tracy,California Eti.9 2M 1-67 Vanguard Press