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FOR OFFICE USE; ---------------I-------- ----- ---------- ------- -- -- -------- -- ------------- ----------- - APPLICATION FOR SANITATION PERMIT Permit No. __��_5......... •-------------.--------- (Complete—in Duplicate) --- y Y�� This Permit Expires 1 Year From Date Issued Date Issued ....................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION F�-W ;? ,, lTR� T� /,A.�H.RC}3 ., Owner's Name------------------- Q -----•-•----= i .AV -'.E --------------------- --- Phone------------------------------------ Address-----------------2_t_!W-........... -------- -K-F�__F—.-77-------------------------------------------------------------------------------------........---------- Contractor's Name -F_R---------- ------------------------ ---------- --- Phone Installation will serve: Residence E�-`Aplrtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .:_V�Number-of _... `Gedrooms .3. Number of baths._ _. Lot size ../ G�.,�tYi4tifG ----------------- Water Supply: Public system ❑ Community systemrivate ❑ Depth t Water Table _�f__ _ ft Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy.Loam Clay Loam ❑ Clay E] Adobe [:] Hardpan ❑ Previous Application Made: (If yes,date-.__..__._......... } No�ew Construction: Yes [❑ No FHA/VA: Yes ❑ No l- l TYPE OF INSTALLATION AND SPECIFICATIONS: r; (No septic tank or cesspool permitted,if4publicsewer-.is_availablew.ithinZ00rfee#.) — y- r �� I Septic Tank: Distance from nearest well-------- Distance from foundAon--------------------Material ----------------------------------------------- F-)aST`r94C! No. of compartments------- ---- -- .,.Size --------- Liquid depth--------- ------- --------Capacity----------------------- Disposal Field: Distance from nearest w ll__ _W..Distance from foundation___. 0_ Distance to nearest lot line---_-��`_. 5_0---- Width of trench------ - -•---- ------------- �j 14(P Number of lines............. ............--------Length of each line.-.;-:_-_._ -_- ¢---- � •d MD Type of filter material._-.�£f.S,K,___Depth of filter material------. _9.--.--..Total length_-_ .. (9----------------------- Seepage ._..__...............Seepage Pit: Distance to nearest well----------------------Distance from foundation...-...-----------Distance to nearest lot line--.........---..- ❑ Number of pits-__ material------................ SizE:,diameter------------------.....Depth------------------------------.-- ir €. Cesspool: Distance from nearest well ----------------Distance from foundation-.-..____._.__.... ..Lining material------------------------------:....... : ❑ Size: Diameter- - -------------- ----------------Depth------------------------- ":--------=--------------Liquid Capacity----------------------------gals. I ye M� ��' ..................... i ist wefl. Distance from nearest building------.---------------_------ Priv : Distance from near❑ Distance to nearest lot line..__._._._____._.___ i �rS_ -------------------------------------------------------- i' Remodeling and •o'rr repairing (describe):-...-- [: ,._. NK----a_EfEb_s-------P --.... ----- y� r • --•--•------- •�------- -411 ._1�:.._�_�?��.": ---J'-��t1�w-----�r_=5------ �_tG!.�.}__.(rl'_,-=�---- �°-p--C=-'='�`---�-,- ---- -----------------------------••-- - •----------•----- ------ q i t -------- -------------------------------------- ------------------------------------- �-� - - --•- ----- --------------------------------------------------------------------------- I hereby certify that I ha-v,prepared this application and that the work will be clone in accordance with San Joaquin County ordinances, State laws, and rules a reulat ns of the San Joaquin�Lccal Health District. ;g k [Signed}.. I -------------- By: � --;,:--•--------------------------------------(Owner and/or Contractor) By:-------- -__ w (Title) - - ) a a (Plot-plan;=showing size-of-lot;�locetion-of-system-in re a#iort-to-wells;buildincjs�-etc. -�an�be�placed�on•reverse-sid�e].�- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ' ' R- ...... -----------•- ----------- --- DATE-------------` 1 r�y ---------------- REVIEWEDBY------------- -------------------` --------------------------------------- - ------------------- - -------------------_-• DATE---- ------------------------------------------ BUILDING PERMIT ISSUED---------- ------------------------------------------------------------- DATE---- ------------------ Alterations and/or recommendations:.------ --- -- -- ---- --- ---------- - -----=-- •- ----•------..- ----------- --------------------------------------- --------- ------:-......... �--------'-'---- ----------------------------- --------------------------------•--------•---------- - -------------- --- --------------- ------------------- ----------••--------------------------- - , ---------- ---- �R -------------------------- --------------------- --------- ------------ --------- --- -------- ------------------ - --- ---------- -- -----. ..._....... - ------ -- ------- - ---------------- ------ ------ -- -------- ------:-------------------------------------- FINAL INSPI=CC710t�1—BY: =----- ----- ------ ----- Date.-- - - = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockton,California Lodi, California Manteca,California Tracy, California E.H.9 2M 1.67 Vanguard Press