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FOR OFFICE USE:" <br /> -------- --------- --­----------- 77- 3Z3 .1 <br /> --------------------------- --------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. ........................ <br /> ---------- (Complefe-in Duplicate) Date Issued ---- <br /> ------------- J This Permiit'Expirgs 1 Year From <br /> rom Date Issued ......... <br /> Application 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. <br /> JOB ADDRESS AND LOCATION------Ag-Ici-Y3------- -.0— 4_<_ C,416 A). CA <br /> ---------------------------------------------------------------- <br /> Owner's Name---------l.-"_l.-R, -------13A.11,1P---C-le lea---------- ------------------ ------ ----------- --------- PhoneAF-3-F—3-F-!7:72-17---7 <br /> Address-------------_-- r'.Vv eo-A e; ....../.VV.<.------------------- <br /> ------------------------------------------- <br /> Contractor's Name-------0,14 ------- ---- - - --------------------------------------- Phone..47.2_7---- <br /> Installation will serve: Residence'M Apartment House ❑ Commercial F] Trailer Court E] Motel E] Other 0 <br /> Number of living units: -1---- Number of bedrooms .3.. Number of baths __2__ Lot size `fir-________________ <br /> Water Supply: Public system Ej Community system'[] Private 51 Depth to Water Table ------- ft <br /> L-Character.of-soil-to a.depth-ot3 feef- Sand,E] Gravel [] Sandy Loam 19 Clay Loam'[:] Clay E] Adobe O' Hardpan E] <br /> I Previous Application Made: (If yes,date------------------- ) No-F New Construction: Yes No E] FHA*/V_—AYesE—Nd <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-./-00-----Distance from foundation-----A®------..Material ------ ---------- <br /> No. of compartments--__-.-_-.j---------- depth-__._-__ ------- --------Ca pa city--,/.Z_�...1�.4 <br /> Disposal Field: Distance from nearest well--1-3-0.-...Distance from foundation---3 ---------Distance to nearest lot line---s-ad! <br /> ❑ <br /> Number of lines----------.7 L------ ------ ----Length of each line-------7P--- ..... Width of trench.........z!. ---------- <br /> W r4 <br /> ----------Depth of filter material--- <br /> x I C) Type of filter material__.__- ....1_7-------Total length------- ------------------ <br /> Seepage Pit: Distance to nearest __.__-Distance from foundation----/--- Distance tof nearest lot-line__40__"_&,19 <br /> K.J Number of pits.._ ..... Lining material------------------- Size: Depth--=--t/Q_........... <br /> -rA <br /> Distance from nearest well ---------- -----Distance from foundation---_--.__------ - Lining material_-_-------------------------------- <br /> Cesspool: �0 <br /> Size: Diameter- -- ------------- ----------------Depth-----:---------------- ---------------- -----Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well.----------- ---------------------------__-----Distance from nearest building_.____-__-_._.__._____________...___._. <br /> � . <br /> ❑ <br /> uilding------------------------------------------ <br /> F111 Distance to nearest lot line---------- ---------------------_----------------------------------- <br /> Remodeling and/or,repairing (describe): <br /> - d-------------- --------------------- -------------------------------------- <br /> -----------------------------------------------------------------------------I---------------- ----------------------------------------------------------------------- --------------------------___---------------- <br /> -----------------------------------------------•---•---------------------------------- <br /> -- ----------------------------------- ---_-------------------------------------------------------------------------------------------------------- ----------------- <br /> --- ------------------ ------------------------_-------- ------------------------------_--------------------------------------------------------------------- -------m-------------------------------------------- <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 and regulations of the San Joaquin Local Health District. <br /> -�-.-(OWn-er—a&nd/,--C:ou:n--tra-cfu-r)- <br /> a' r <br /> B ----------­-------------- <br /> ------ --------- <br /> y:---- ------- ,,, ------------ ---------- ----------------------------(Title <br /> side <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverseA <br /> FOR Ai PARTVENT USE ONLY <br /> 71 <br /> APPLICATION ACCEPTED BY------ - ---------------------------------------- DATE---�_ <br /> REVIEWEDBY------------------------------ ---------_-- ------------------------------- ----------- ------------------------ DATE----------- <br /> BUILDING PERMIT ISSUED-------- -------- ------------------------------------------------------ ------------------ ---------- DATE------------------------------------ <br /> Alterations and/or recommendations------------------ ---------•------......-__1_____1---------- ----------------------------------- -------I---------­_­------ ------------------------------ <br /> ---------------_-------------- --------- -------------------­----- ---------- -------------------------------- -------------- ------------------- ---------------------------------------- <br /> ---------------- ---------------------- ------------------------------------ -------------------------------- ------------ ------------------------- -------------_ --------------------------- <br /> f <br /> ---------------------------------1---------- ---------------------------- ----------------------------------- ------------------------------------------------- -­ -------_-----------­- <br /> ------------- ------------ -- ------------- -------------- -- -------- ---- - ---------------- ------­.­----------- ------­------I------ -------- ---------- --------- ------------------------------- ........ <br /> 11, <br /> -- ---------- <br /> FINAL INSPECTION BY. . ..... ------------------- Date..... -- ----/---- - --- ---7------ -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRI <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Str'Let 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California <br /> Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />