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FOR OFFICE USE: -----------------------=------------------------------ -- ------------------------------------------- -__......................:..............._ .__- ___ ---" APPLICATION FOR SANITATION PERMIT Permit No. _ ..:_...__....__... ___-_._.1_____ --------------- ----•-- --------- (Complete-in Duplicate) ...___.._. _._._____________ This Permit Expires 1 Year From Date Issued Date issued Application ishereby 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._5"E------- -•---�-�'d,."c �n 1��:• - C.1�..�''�d Owner's Name-------------------t r �----_---- ---------•---- -------------------- -------------- Phone------------------------------------ --•� Address------------------------ 6___.-a -..:.g:� ----._��__�:�.!�......-- /__n: jV e R-I-- tv. -------------..._ ------------------------------------------ - s -------(10_1--d--------------- Contractor's Name---------------- ---------- ------- -------------------------------------------- Phone-------•----....................... Installation will serve: Residence Eye Apartment'House ] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: A.---- Number of bedrooms ,sem'._ Number of bafhs f mot size ----------------- Water ------------- -Water Supply: Publics stem Community system pp y� y ❑ �i�.�r �A��I ❑ Private �''Depth to Wafer Table,�,�o_ ft ' Character of soil to a depth of 3 feet Sand j''ZGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ ,i Previous Application Made: (If yes,date.! __.._"-___ ] No New Construction: Yes � No ElFHA/VA: Yes E] No �.-� r PE OF INSTALLATION AND SPECIFICATIONS:__. -. ' No se ttc tank or cess ool ermined if ubhc wer is available within 200'feet. - " Septic Tank: Distance from nearest well_) Distance from foundafion:_.1_7_..____-Material ""...."s __a— ev, No, of com artments""._____.. Liquid depth..._'.'.._ Capacity__1•� �_,%#�� p ..----------Size_9'X_.6:� 40---- y disposal Field: Distance from nearest well_.,�Y......_Distance from foundation----- �_..____.Distance to nearest iol, line ._f___ [ Number of lines______________" Length of each line-...-___�R�... Width of french._""_�._..___ - -------------- Type of filter material__.-__ _a .�C_______Depth of filter material-___..�. __________Totah length___;__._ Q_______"______________ s- Seepage Pit: Distance to nearest well------ -----"---------Distance from foundation----------------�'_ Distance to nearest lot line------- El. Number of pits--- ------------------Lining material---------------------- Size: Diameter,+------- --------------Depth......._...---------------------- Cess"ool: Distance from nearest well _____________ "_Distance from foundation_ 1 .._ Cesspool: -- ;:.-Lining maferial- •--------- ------------------- N _ f Size: Diameter- De th --- ----- `.,?Liquid .Capacity--- - ----- ---------------='gals. ❑ p . : Privy: Distance from nearest well-----------r_____----------_--------------_____ __Distance from nearest building______-_..__.________..__.___._________- I ❑ Distance to nearest lot line -------------------------------------------------------••---- --------_------------------------- - ---------- - ----------------- Remodeling and/or repairing (describe):----- -- ------ --------- ------------------•----------------------------}-- --------------------------------------------------------------- ---------------------------------------------------------- ✓` 5 ---------------- ---------------------------------------------------- -----------------•--- ----------------- -•--------------- -----------------------------------------------------------------°---------- ------------------------------ ''�'_ f hereby certify that I have prepared this application and that +he work" will be done in accordance with San Joaquin County s`ordinances, State laws, and rules and regulations of the San Joaquin'Local Health District. (Signed)-• - -- - ...:. ------------ - ----- - ------{Owner and/or Contractor) . - - ,, .,.. - :. ,-� -- - - - y.._.. - ----- .- ------ ----------------- - - - (Title)------ (Plot plan, showing size of lot, location of s+e' in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._._._ 1 __-_._ _ ------ --- _.." -- ----------__ - DATE"_..._ --------------- REVIEWEDBY------------------------- --------------- --- ----- ----------- ---------------- ---------------------------------- --------- DATE---------------------- BUILDING PERMIT ISSUED-------- ----- ---- ----------------------------------------------------------- --- --- ------------- DATE Alterations and/or recommendations:------------------ ------- - - --------------------------------- -------------------------------- - - ----- .-- - ---- ------------------ a ------------........................ ------------- --- ..............LON FINAL INSPEC BY- . . - Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street it"kion,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vonguard Press