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I-UK Ul- lYt: USk: -------------------------------------------------------- -------------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. . .F'.�33 - ----------7- ----------------------------------------- (Complete in Duplicate) p Date Issued --------------- This Permit Expires71 Year From 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. C7fj 3Z 6, F_ . ,�Zt v+t e40 S© ' JOB ADDRESS AND LOCATION__-SI-17 ---------RE R ,._3S----____________ Owner's Name----------CL_A.VoJI�------•-C------••- ----- L 1 ------------------ ----- ----------------------- Phone------------------------------------- D Address,-------11- - --`----13 p K•-----r2---g r2----R-A--------------- -C44�0 = v 'e-Contractor's Name-• p-W-N-e-7�--------------------•------------------------------ --------------•---------------------•-- - •---- ------ Phone----------------------------------- - Installation will serve: Residence ❑ Apartment House ❑ Commercial [:❑ Trailer Court Motel ❑ Other ❑ _ Number of baths _ .___ _____Lot size _GR�1._6�:___:___________________ Number of living units: _ .-_ __ Number of bedrooms .� _ �_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table /.-ft. Character of soil to a depth of 3 feet: Sand 2-"Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-------------------- No ET__ New Construction: Yes �o ❑ FHA/VA: Yes ❑ No { Ej--- TYPE.OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted 1f public sewer is available within-200 feet:) Septic Tank: . Distance from nearest well----- 4?__-__-Distance from foundation-----ID__-.-_ -. _ Material__<ZON�R_�--M�-__..____. [!� No. of compartments--------�r-.__________Size__rx____ Lk_5-Liquid de h____ —-_-_-Ca acitY--/1�-42-0 ---- Disposal Field: Distance from nearest well---5 /...._Distance from foundation_______/0--.-.Distance to nearest lot line---S_-_------- Number of lines______._7;�=------------------Length of each line-----------Z�------.-------width of french........36~ -----_ Type of filter material__R0C._r—_,___Depth of filter material___ 47....-.__.....Total length-------------- ---------------- Seepage -_____________Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-.-__..___.____._ 0 Number of pits----------------------Lining material----_-----------------Size: Diameter-----------------------Depth-----------------_-------------_- W. i , ea, Cesspool: Distance from nearest w`eIL----------------Distance from foundation--------------------Lining material------ C ❑ Size:-.Diaizieter__. �-...... - .Depth-------- ---------------------- =_......•-• ---•-. ------Liquid Capacity----------------- ------gals. r,. a. � Privy: /Distance from nearest well___ .____-'..:__---------------------------- __Distance from _ nearest building-------------------------------- d ❑ Distance to nearest lot line------------------` t - - ---------------------------•---------------- ------------------------------------------ Remodeling and/or repairing (describe):____.._____ -- -------- ---------------- ---------------------------- I ------------------ ` ---------------------- ----------------------------------------- ---- -------------------- ----------------------------- --- I hereby certify that I Have prepare this application and that the work will be done in accordance with San Joaquin County f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) --- -- ------- ----- ---------------- -----;------- ----------------------------------- --------------------------------- - {Owner and/or Contractor) BY�- ------------------- ---------- -- --------- - ----------------------------------------------------------------------------(Titia)----------------- .----------- (Plot plan, showing size of lot, location pf system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY !` APPLICATION ACCEPTED BY- T:R' Q =---------------------------- -------------------------------------- DATE- - - s REVIEWEDBY------------------------------------------- --------------------- -------------------------------------------•------.------- DATE_ - --- BUILDING PERMIT ISSUED--------------------------------- --------------------------------------------------- ---------- DATE------------------ ------------------------------ Alterations and/or recommendations:-------------------------------------------------------------------------------------------------------------•----------------------- -------------------------------- ------------------- •----------------- ------------- -------------------------------------------------------------------------- --------------------------•----------------- : ------------------------------------------------------------- --------------------------------------------- --------------------------- --------------------•----------------------------=-------- --------- ----------------------------------------- --- --------------------------------- ------ -- ............. - ---- --- ----- ---- --------------- - ----------- --------------- ----------- -------- -------------•-------- ------- FINAL INSPECTIO Date - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockt on,California Lodi,California Manteca,California Tracy,California r F.p.CC.