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FOR OFFICE USE: ---------------- ------- -- - ------------- APPLICATION FOR SANITATION PERMIT Permit No. ...................... ---------------------------------- -- (Complete in Duplicate) Date Issued ........... _.-_-----.......-----_,_________._-__--__-._.-------- This Permit Expires 1 Year From Date Issued - --' Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with Count Ordinance No. 549. 2r� i/_ �use O� V-P PP ` ' P y * /`� ,jam faf JOB ADDRESS AND 'LOCATION_ ��_Q�--�0 %.Z ,-1,.��-n_r�-e-M.�Gr3 6.moi 3 N a u Nc�4 fV �uc�r�-fid Owner's Name-------�r,.,�..t]-----�-0--�--��---�-�F�-�--•-------------- ---------------------- ---------------- -------------. Phone_.,_5-.6_5 Address----- - - -)--- in- ° --- -- - - a s ---------------------•------- ----------------------------------------------...._...--------------------------------- Contractor's Name---- 1 H � 5� 1 -i-------------------•----. Phone..11��,e�----Fd%,-,/ Installation will server ResidenceA Apartment House ❑' Commercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units: --j-- Number of bedrooms _- Number of baths __I__ Lot size ----//d/---)1(24 - Water Supply: Public syste im�X""Co➢rrim unity system ❑ Private ❑ Depth t-Water Table �1- ft. Characte Mof soil to a depth!of 3 feet Sand ❑ Gravel 0' Sand „ am Cay Loam ❑ Clay ❑ Adobe❑ Hardpan [] 41 Previous Application Made. (I,:f yes,elate.__ No ❑ New.Construction: Yes 4❑ No ❑ FHA/VA: Yes ❑ ❑ t #1 #° s . TYPE OF NSTALLATI AND SPECIFICATIONS- � �# Septic Tan septic tank permttte�d I�ubhc s�-ewer as availabae�wtthin 200'#eet)� � { No' ,r1+� p Distan'c�e' from nearest well • ___ Distance from foundati.o'n --------a.Maferial--------------------_------------------ --------- 'h --------------------Capacity p i Disosal Fi Id: Distantye from nearest we L..._ tength tance from foundation __ 1_ie =__.Distance to nearest lot lineNu r '�f lines________________ _ _ of each line_______-��%',-_.Width of trench.____.V��`.__._______._ Type of filter material_ Depth of filter material-----A-- .�-___Total length__.___-_�Q_______________--_-_.__ � ....-- - J3 Seepage Pte: Dis a"n�ce to nearest well------ :J". Distan If- i' foundation-- - --_Q_______-Distant to nearest lot line_,___.- . Nun r'of pits---------,1---------Lininja�,`material__ .Size: Diameter----- Dept th �J ------ ------ 111` Cesspool• Distance from nearest well .&-Distance from foundation------------ ___Lining material--------.._.__..______________--__. ❑ Size; Diameter------ ---------------------�O-Depth---- -------------- -- --- --------------Liquid Capacity------------------------- -gals. . Privy: Di sta.'i�elfrom nearest well_-_ '�►_;__.________________ Distance from nearest buildin #�+t` iA g ❑ Dista. " to nearest lot line.-------- --M---- --- -------------------------•------------------------------------------------------------------------------------ ------- Remodelingand/or repairing describe :-------- o, 9-/ LC..�L� �/I --- l��T/J --------------------------------------------------- ---------- --------------------------------------------------- --------------------------------------------------- ---------------------------- -------- -----------------------------------------------------------------------------------------------------------•------------------------------------- ------------------ ----- -------------- --------------------I---------------------------------------------------------•------------------------------------------------------------------------------------------------------------------ I hereby certify that,l haye5,:prepa�red this7a p i a ion and�fhat the work wi11[Ve done in a'"cco dance if rSan Joaquin County ordinances, S 1 t1Wa s, ani! ru��°sad �regulat o1 ns of thr` J aquiiLacal Health�Distr et1"'� � (Signed) r 4�f�------- By: �/5f-. f ---------------------------------------------------(Owner and/or Contractor) By:............ .. - - - --- -- ----- -----------------------------------------------(Title)-----0�Wit-- ------------------------------------ (Plot plan, showing ize!of lot, ation of system in relation to wells, buildings, etc., can be placed on reverse side). � 1 j FOR DEPARTMENT USE ONLY APPLICATION ACCEP..TED BY----- L--G------------------------------------------------------------------- DATE 3 � REVIEWED BY-------------1-------- -- ----- --------------------------- DATE ---------•-- ----------------------------------- BUILDINGPERMIT ISSUED-j------------ --------------------------------- - - DATE----------------------------------------- -- ---------------� ` _ Alterations and/or recommendati ns:....... _._� - �- { ,------- r` ---------- ----- -- ----------- ---------------------------------------------- -- --------------------------------- ---------------------------------------------- -------------------------------------------------------------- --------------------------------- ------------ --- --------------------- - FINALINSPECTION BY-------------- - --- --- --------------------- Date------- --- ------- --------------------------------- SAN JOAQUIN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California F.P.CC.