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FOR OFFICE USE: <br /> f✓ <br /> -- ------------ --- - -- ------ ---- <br /> APPLICATION, FOR,SANITATION PERMIT Permit No. <br /> This"Permit Ex Ire �. <br /> t -- Com lefe•ln Duplicate) - �—/e—�k <br /> �" -_ � ""s 1-Year From aafe Issued Dateyissued-. <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. F <br /> I JOB ADDRESS AND LOCAT ON._ b9---__ <br /> Owner's Name---------- -----•-- ----- <br /> ------------------------------------------------------------- <br /> ----- -- ------- -- ---------- -----.- Phone---------- ------------------------- <br /> Address-----_------ <br /> ------------------------Address------•------ .. ----- - - __- <br /> --------------------- ----------------------------------------- <br /> .... <br /> Contractors Name._._. .____ �- 7� • K, ar <br /> ----• ---••- ----------------- ---- - ---------------------------- - --- ---- Phone__ .-. <br /> f 'Le Y-------•------- <br />` Installation will serve: Residence �` Apartment House- ❑ Commercial ❑ Trailer Court ❑ �Mofel ❑ Other ❑ ' <br /> T f <br /> Number of living 1 units: _. ____ Number of bedrooms _. tZ-_ Lot size <br /> � �___. Number of baths <br /> Water Supply: Public system"[] Community system [I Private [Depth to Water Table_6f-ft <br /> Characifer of soil to�a depth of 3.feet• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam D Clay ❑ Adobe Hardpan ❑ "P <br /> Previous ApplicationIMade: {If yes;date-------- } No E] New Construction: Yes e—/ No E] FHA/VA: Yes Er--No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [(No septic <br /> . tatnk or cesspool permited if pubiirt.$ewer_is,avallable within 200,feet. <br /> SePticlTank' Distance from nearest well#--------------- <br /> D <br /> - -- Distance <br /> o Iuir <br /> - Material No.!of compartments-----_i ___ ----ze ,.5"� K.9��'Liqd depth - -- -----. Capacity <br /> 1 <br /> 4 <br /> Disposal Field: Distance from nearest well._+S Distance from foundafion_1O.._.....•_...Distance to nearest lot lineES`.......... <br /> Number of {ines.--__°�._._-- L"--- engfh-,of each line- 76-------- Width of trench__�.4,_ `------------------ <br /> Type <br /> ---------- ---- <br /> l ypl; �'�/�� ' + . P l _„r_• Y- .--- <br /> - otaf length--------�-bra--�--------------- <br /> - T e of filter material-- DG-�� -y'De th of filter _�- ___ __ <br /> Seepage Pit , Distance fonearest \, l@/._. - �---.Distance f m fvundataon_g____.- Distance to nearest lot line. � �}fA` <br /> �� ---._� - '. __ Size: Diameter-'--__3• .�� <br /> ....,..,r _----Depth- a2�F------- ------ <br /> �-� Number-of.� 1ts�r�.. Linin ma r � <br /> Cesspool: Distance from nearest weftf ..� ------Distance from foundation.........._...... ..Lining material-_...____- _...___.._.__.___._._._ <br /> { Sizer Diameter- ------------- --- ------------Depth------------------------------ - - ------------ Liquid Capacity-- ----- ----------------gals. <br /> Privy: Distance from„nearest well-.-J......................__..-- ----------- .-Distance from nearest building_-- .____....._ __.___-. ._._ <br /> 41 - <br /> ❑ Distance toy nearest lot line -- ----------- - t <br /> c • <br /> --------------- <br /> Remodelingand/or re Sairiflg(describe): .` _.�” 1 <br /> � - - P g t :. <br /> -------------------- -------------•------ = <br /> ---------- ••--•------------ - ---j_._--------- ------• ------------­- ------ --------------------------------------------------------------- I--------------------------------------• )----------------- <br /> C- It r i <br /> C f <br /> I <br /> - _ <br /> ordinances, tate laws,sand rule and re Mations"of a----------------a -ha h -- r will -- - n -� ---------------------------------------corSa ---------------County I herebycertify'that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> g the San Joaquin Local Health District., <br /> r <br /> Y <br /> Si ned -_.-.-----.-_..._-----------------_-------...(Owner and/or Contractor) <br /> { 9 ,)------------------ - • = <br /> I <br /> { 18Y ------ ----------------------------- -•-------- --- ----------------------------------------(Title)....-- --------- ----------- --- ��---....----------- <br /> Plot plan, showing size iof lot, location of system In relation'to wells, buildings, efc., can be placed on reverse side).! <br /> 4 1 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------._i- <br /> -�1--�------------------- ----- DATE-- --------'�-----as------ ---- --------- <br /> REVIEWEDBY.-=--- ------------------ ------------ .-_----------------------------------------------------------= --------- DATE----- - o <br /> BUILDING PERMIT ISSUED-------- -- ----------------------------------------------------- ------------------------------------ DATE-------------------- ' <br /> Alterations and/or recammendafions:Y <br /> ------------------------_ __ <br /> ---------------- ---- -------------------------------------------•------•----•-•------ ---------------- ----•------------------- <br /> 1 I <br /> ----------a ------------------------------ ------ �1 <br /> f <br /> ---------------- -----.-. <br /> - -------------------------- <br /> '? is ------- • ----------- ------•-•-------- ' <br /> i <br /> FINAL INSPECTION BY. ...----- -------- <br /> ' ryA i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT , <br /> e <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 5locklon,California Lodi. California Manteca,California w.r*�r~ Tracy,California <br /> E.H.9 2M 1-67 Vanguard.Press <br /> t <br />