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FOROFFICE USE. .. ---------------------� ------ "`j ----------- APPLICATION FOR SANITATION PERMIT Permit No. .. - ----- -------=-------- ------------------ -- (Complete-in Duplicate) fThis Permit Ex ires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh 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' LOCA ION-------�✓�L3 4_�[-un ----- --- R D- Owner's Name-----------•--------- � QH`" �-----------L�. = ---------------.------------------- Phone. 1 - - - -- -• -- -- - Address-------------------------------- Contractor's Name---C) fSl.i=P __5555 `' , ---------------- ----- ----------- - -- ---------------------------------------------- Phone------ ---------------- Installation will serve: Residence 0 Apartment House ❑ Commercial Trailer court �F6RW7 ❑ ❑ Motel ❑ Other ❑ F Number of living units: "._ Number of bedrooms'.. Number of baths'__ Lot size --... 0C_R.F_R.C7�_______________ - --5555-- Water Supply: Publics stem 1 pp y� y ❑ Community system ❑ Private pa--[5epth to Water Table/Z. ft Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------------...._ 1 No�New Construction: Yes ❑ No 9j-- FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: Nose tic tank or. cess ool ermitted-if-W�lic sewer is aveilabfe witkin 200 fee+.} Septic Tank: Distance from nearest well_..-5 .---Distance from foundation--___1Q_------- Materiai---C-01V f .5555__ ['� No, of;co'mpartments----:�--_.. Size-3-u 9_,.._ ..Liquid depth_._ Z- __. -.Capacity, �a Disposal Field: Dista eA from nearest well-.. __....-ktance from foundation-_,/ 5554_...___..Distance to nearest lot ❑' r€ NuniFie`r of lins"� "_�� --------- ` 5555- linef-�-- ----------- ------ W � --------. _-------� Typero -(---.---5-5-5-5--- �v � f� r _i �-G _ Dpth ofermaera . c___.._. ota! Iength5555-------------- -------- Seepage Pit: Distance to nearest well _... Distance from foundation --5555_. --- Seepage to nearest lot line----------------- ❑ Number of pF#s--- .-5555-- 5555 --Lining material------ �__ Size: (}ie�meter--------------- Depth-------------- - r Cesspool: Distance from nearest weq ------------'fit Distance from foundation................. . Lining material-_.--------------___._ ❑ Size: Diameter. Depth --- Li, uid Ca acit ------ - --- "" q P Y _. gals. I SOL-' •--- 5555- -- -- -- Privy: I Distance-from nearest wee - _.—.-------___-- /.- � pistance from neares+ building 555}5,_ ❑ i Distance-to-nearest Iof4ne. —._. : ___ -- _y r -. -- ---- ----•=-- -------------------- # Remodeling and/or repairing _- — ----- J-'�. ------ -- ---------------•5555------------------------------------- .555 --5555-- --------555555 55-------------------------- --------------------------4-- - ? - --55555555--••555.5- 5555--` 1 -5555-•5555--------- --5555-- ---555555 55-5555---•5555-- --5555---5555-- --- -------- ------------'-'---------------------------- ---.,.-...---------------------•----------------------- --------------- �t t 1 SCI f lu,.I ----------}------------------ ------ ---------- •----- -------- " ------------------- ------------------------------ ----------- ---------- ) 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State4aws, and rules and regulations of the San Joaquin Local Health District. ! s (Signed)--- -•--:, --------- � I t -- ------------------- ------- -5555-- ...�:,�..,..�(Owntr an/or Contractor) oD --•- -5555-- -� -r�r _� .# - =,.. ...� 5555,: >-e - , .m, •_ 5, - - -- - --- (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f F rui FOR DEPARTMENT USE ONLY APPLICt CCEPTED BY--------._._L--f..�_-_O_" ----------------------- ------------- --------------- - DATE----- �� REVIEWED BY.. -j - - --------------------- DATE-----------5..... A I N ,A - ;II - - . .. - 5- x. _ -------5555.-5555__-.._.5555---5555-5555-. f BUILDING PERMITi ISSUED- . -.� --��f __- `�?�kN_K.----�N�TAL-L-��-----fir- --- .pATE-------------5555-- + Alterations and%or recommendations:_-_._5555 . -_ -_------ ------� � . ,� _. � __ ..._ � T; --- - -------------------------------------------- -- �-------------- _ -•-------- 5555-- - •---•---- 5555-- - -•'-1�- --� -�- •_� �.. �__ �—r __._ .__ _r - ---- -•�5555- �. --- -- XT _5tfdrit-:�:a4 Q-- — - - - .... ---- ------ ,. f FINAL Date--- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi. California Manteca, California Tracy,California E.H.9 2M 1.67 Vanguard Press