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FOR OFFI�`E USE: <br /> ---------------- ------------- wIlf- <br /> 1p, SANITATION PERMIT Permit No. <br />--------------- -------yi__&------- -------------- <br /> APPLICATION F6 <br /> ------------ --- -------I------- (Complete in Duplicate) <br /> Date Issued <br /> ------------- <br />------- ---------------------- This Permit Expires I Year From Date Issued <br />--- ------------- <br /> Applicaticiii is hereby made 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. r5cpLory <br /> JOB ADDRESS AND LOCATION._.__ <br /> _TA-----?r)------lro-----No-----A -_A�-c� <br /> Owner's Name--------------- -----------_St -sl-7m-------------------;-------- ------------------------- Phone---------------------------------- <br /> A? -F= r\f --------------- <br /> Address...-------------------/3-5-5-----------F7 Al--------A-V-----------•:---------- --------------------- -------------------_---- <br /> Contractor's Name-----*AA F��--------------------------I------------I--------------------- ----------------------------------------------------- Phone----- --------- -------_--------- <br /> Installation will serve. :Residence. El 'Apartment House 0 Commercial [I 'Trailer Court Ej Motel 0 Other E] <br /> Number of living units: Numbd of bedrooms -------- Number of baths -------- Lot size ____-A 5=R E)q Gr ---------------------- <br /> Water Supply: Public system E] Community system 0 Private 0_-­�epflri to Wafer Table aZ-ff.' <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam 0 Clay Loam Kj-'Clay [] Adobe E] Hardpan E]� <br /> Previous Application Made: (if yes,date...................r) No Er New Construction: Yes L] No Er" FHA/VA: Yes ED No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer-is av'aiIa6Ie-'Wifhin 200 feet.) <br /> SepticTank: Distance from nearest well-------- --------Distance,from foundation--------------------Material-------------------------------------- ---------- <br /> ElNo. of compartments----------------------------Sizq%----------------------------------Liquid clepth---:----------------------capacity-------------- <br /> Disposal Field: Distance from nearest we1_51P,......Distance from foundaf16n__10--------Distance to nearest lot line---�5------ <br /> I 6'N <br /> Number of lines------------6---------------------Length of each line-9 -��� <br /> ()J�Wiclth of trench_....;?Y.-t----- - I <br /> - �2`6 0 <br /> Type of filter maferial_F_-0CK----Depth of filter material__.__ 1----.-Total length--------- --------- ------------------- <br /> Seepage Pit: Distance to nearest well___5- -------Distance from foundation-----J 6--------Distance.to nearest lot <br /> f pit _-2 Lining material___RQaj--,__Size: Diameter_Jb_X_l�2—. __Depth....__�7f 11 <br /> Er� Number os--- —-------- - ;�� ---------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----------------Okxining material-..___.._._.._._-__ <br /> Size: Diameter----- ------------------------------Depth-----------=° ------------------------------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well------------- ------------------------ --- _....Distance from nearest building------------------1-------------- -------- <br /> 0 Distance to nearest lot line - - ----------------------------- -------------------------------------I---------------------------------------------------------- ----------- <br /> Remodeling and/or repairing (clescribe):------AlVi-m014-----` 0-------7Fx-I-ST I-&6--------- -------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------I---------- --------- --------------------------­---------------------- <br /> ---------- ------ ------------------ ------------------------------------­------------------------------------------------------------------------------------------------------------------------------------- -------------- <br /> ------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------- - -------------------------- -- <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 d.regulaflons of the San Joaquin Local Health District. <br /> ct <br /> ------------------------- - and/or Contractor) <br /> ................................ <br /> ............ ....... <br /> (Signed)----- ....... <br /> 0_*A_.2_. <br /> By:------------------------------- ------------------------------------------ --------------------------- -----------------------------(Tif le)---------------------------- - ---- -------------------------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT,USE ONLY <br /> APPLICATION ACCEPTED BY.----- ----------------- ------- ----------------------------------------------- DATE----------7--_177.4. 5-------------------------- <br /> REVIEWEDBY---------------------------`---------------------- --------------------------- ------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------- ------------------------- DATE------------------------- -- ------------------------------ <br /> Alterationsand/or recommendations--- --------- ------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------I --------------------------------------- ------------------------------ ------------------------------------------------------ ----- ----------------------------------------------------------- <br /> ---------- - -----------------------------I..�----------------------------------------------------------------------------------------- --------------------------------------------- ----------- ---------------- --------- <br /> ------------------­------Z---------- ----------------- ---- - --------------- ----------------------------- ----------------------- ----------------------------- -------- ------------------------- <br /> --- -------------- <br /> --------------------------- --------------- - ---------------------------------- ---------------- --- ------------ -------------- <br /> .l�- o------ --- --- -- --- ----- <br /> 7 Date- - - <br /> ------ --- ----------------- <br /> FINAL INSPECTION-BX:- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave' 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Slocklon,California Lodi,California Manteca,California . 'Tracy,California <br />