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FOR OFFICE USE: j -------------------------------------------I ---- ---- APPLICATION FGR SANITATION PERMIT Permit No. _1q - --------------------------------- 11� ! ----------------- ----------------- -------------------- (Complete in Duplicate) Date Issued ----------------------------------------------------- --- This Permit Expires 1 Year From Date Issued i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap94,4 %io eacl in o I' ince with,County Ordinance No. 549. �+ �Q ttJJ _d L7 t f J�J p JOB ADDRESS AND L CA11T��O --Dt. -W-/--- I-' .o -sys---------91._1f OF------ � 1�I I Q-AS----------- - A 1.11 1 Owner's Name----------- __j0t K-- A� -------------------- Phone r Address-__------------ ------------ ------ - - -----`- ------------46- ------------ ----------- h N Contractor's Name � r4 -----------•-------•---------------------------------- -----------------•-------------- Phone Installation will serve: Residence Apartment House ❑ Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-I-____ Number of bedrooms -3-- Number of baths'Z-- Lot size -----Atm"&F_ _____________-__ Water Supply: Public system ❑ Community system ❑ Private 113"'Depth to Water Table Wft. Character of soil to a depth of 3 feet:~Sand ravel ❑ Sand Loam ❑ Clay Loam ❑ . Clay ❑ Adobe ❑ Hardpan E] Previous Application Made: (If yes,.date--------------------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLA_TIONTAND�SPtECIFICATIONS: ... 0 F(No septic tank or cesspool permitteI d if public sewer r is ave available within 20 eet.) � - Se tic T k: Distance from nearest well___4_;__,Distance from foundation__�A9_______- Matariaf__ LD _ r __ __- r p No. of compartments_--_---�----------Size-_-X10_X_�_Liquid depth_-_S---.-----__Capacity____/2®-0. r Disposal F' Id: Distance from nearest well...5-0- --_Distance from foundation_-10---------Distance to nearest lot line---,!5_-- ------ Number of lines__:___-___ -- f� ________________Length of each line_- - _. _ ...... of french---------- -__ ___-._-____.---- Type of filter mat Depth of filter materia!------ ------Total length------------ QQ______---_-__---_ Seepage Pit: Distance to nearest well-----e_6_____ Distance ,from foundation_____ --_ la-------- to nearest lot line-__� _.-_ ®� -Number of pits-!-----1_-__-._.-.--Lining material__ ¢ j -^.Size: Diamete r-3-X--'.Depth____-$ ____ -_____- Cesspool: Distance from nearest well-_-- ----.-Distance from foundation___-------_--___-_.Lining material----------------------_.------______ : ❑ Size: Diameter-- ------------------------ - -------Depth------------------=-- ------- ------ - ------------Liquid Capacity- -------------------------gals. „f \� Privy: Distance from nearest we{I---------________________________-_._---------.-Distance from nearest building_---_-.-______-_______________-___.___._. ❑ Distance to rearest lot line-------- - ----------------------- --------------------------------------------------------------------------------------------------------- t 4L_ TM Remode4ing and/or repairing (describe:--------- D�------- ------- ^f_ ........ � � ---TZ7 =------•----•--------•--•------------•--•-------- r t r -----------------------------------------------------------.----------------------------------------.----------------------------------------------------------------------_------------------------------- . I ____ ___________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,, State laws, and rules and r I tions of the San Joaquin Local Health District. - ----------------- ------- ---- Owner and/or Contractor (Signed)-4------�__ --- - --- -------------- -- -. - ( / I - --- •-- _---------------------_------ Ti+le- - _---- _: - ---... ...= = {.. -) i (Plot plan, showing size of lot, location of system in relation to wells., buildings, etc., can be placed on reverse side). r . I � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------------ - ---------------------------------------- DATE------- --— r -----�' --------------- REVIEWEDBY---- ----------- --------------------------- ------------------------------ --------------------------------------------- DATE---- --------- ------------------------------------------ BUILDINGPERMIT ISSUED-------------:------------------------------------------------------------------------------------------ DATE-------------------------------------------- --------------- Alterationsand/or recommendations:------- -- ---------------------------------- -----------------------------------------------•---------•---------------• -•------------------------------------ I ---------------------- ------------------------------------ ------------------------------------------------ -----••--•---•---- ------------------------------------------1-----------------------_----------------- --------------------------------------- p'x---------------------------------------------------------------- I __ ____________________________.___ ------------.--------.--------------------_---_------_--_._------__.___-______-_ r ------------------------------ .-__-__-- _.._. ..._------ ' '--- -- - - ' i >[ - FINALINSP B ! - -----_-- ---------- � Date---- - - -r-�._�'-1---1. ------------------------- t SAN.JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockfon,California Lodi,California Maritteca,California Tracy,California F.P.C C. {