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FOR OFFICE USE: <br /> ------- ------------------- - ---- --- <br /> -- --- _ <br /> -------- _-___ -_._--.-- ---____-....--_-- -.- APPLICATION FOR SANITATION PERMIT Permit No. ._.(,?�.Zl' <br /> ------------ .........:--------------------- . = (Complete-in Duplicate) <br /> Date Issued , .-J/'. a <br /> _"...................... ......_..--..-.. _-__.--__ This Permit Expires 1 Year From Date Issued <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. <br /> JOB ADDRESS AND LOCATION----/R4r*ry------Sx---c rr�l.� �ri�t----------------- ----------------------------------------------------------------- <br /> Owner's Name >e?A__114�.f^'�---------------------- ---------------- Phone------------------------------------ <br /> 1 t, ; ) <br /> Address--------------- -----------------------------------' -- ------------------------ <br /> Contractor's Name f-� = � s!Y//"`--------------------- ----- ---------------------------------------- Phone------.------------------------- <br /> i <br /> Installation will serve: Residence �partment Housri ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of jiving unitsNumber of bedrooms Number of baths.--/--- Lot size - D.---.._._-___-_.....- <br /> Water Supply: Public system Community system,[I Private ❑ Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q­Mardpan ❑ <br /> Previous Application Made: (If yes,date..........-...... } No New Construction: Yes ❑ No ®~" FHA/VA: Yes ❑ No Z�— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank:,-- Distance from nearest well................:Distance from foundation--------------------Material ....---..------.-..--_-..-.--------------"-.--. <br /> No, of compartments------------- ------------Size-------------------- ----- Liquid depth ........ ..__ --------Capacity <br /> Disspoosral Field:, Distance from nearest well.......-"........Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ;q`GJr'� Lj✓ Number of lines ------------_--------- ----------Length of each line-- ---------------------------Width of trench.--------------------------------- <br /> Type of filter material-------------------------Depth of filter material....-------------------Total length------------------------------------------ <br /> Seepage <br /> ---------.-..-.----------. ."..--Seepage Pit: Distance to nearest well-------- --------.Distance frog-n !fouu'nndation-.J�..�--- Distance to nearest lot lins--Z�_�-- <br /> - . : <br /> I <br /> Number of pits-- . l__..-.-._--Lining material-- t94e_ . Size: DiameteC. aJ.-_-.--.---Depth-,?a�-------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material------------.--------...._.-----.-- <br /> El Size: Diameter. .. ----------------Depth--------------- ----- -----_--------Liquid, Capacity -----gals. <br /> Privy: Distance from nearest well----------------------------------------------_.Distance from nearest building.----_-"___------------------------------- <br /> ❑ Distance to nearest lot line <br /> -------------- <br /> t <br /> - ---------------- <br /> Remodeling and/or repairing {describe ..--__ ------------- <br /> - / ----------------------------=------------------ <br /> - -- --------I--------------------------•-------------------------- ------------------------------ ----------- -------------------------------------------------------------- <br /> I hereby certify that I hive prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> [Signed)-------- � � 4C)w <br /> (Signed) Contractor) <br /> Plot plan, showing size of lot' �f� - Title) - w;a....._ ............. <br /> ( p g ,. ; location ystem in relation to wells, buildings, etc., can be p act ed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED --------------------------------------------------------- DATE.-._,111_44-------------------r------------ <br /> REVIEWEDBY----- ------ ----------- ------------------ ------ DATE--------------------------•-------------------------------- <br /> BUl' I G PERMIT ISSUED.------- ----8-- - --------------------- - -------------------------- ---------------------------- • DATE------------------------------------------------------------- <br /> Alte�`r�tions and/or recommendations:----------------------------------------------- ------------------------------------------------------------------- ---------• <br /> -------------- --- -------- " -- - ----• ------ ------ - --------------------------•-----------•-- --------- -- - ----.......------------------------------ <br /> ---------------- --------- -------------------------- .-- . --.------. ----------------------- ------- -------- - ------------ ------- ------------ ------ --- ------------------------------------------- <br /> FINAL INS INSPECTION BY: ;f � �� / � l"� Date......I.__ Ljn . 69--�............................ r'J <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelion Ave. 300 West Oak Street' 124 Sycamore Street 205 West 91h Street <br /> Slocktan,California v Lodi„Califo�rniol r _ £. Manteca,California s Tracy,California <br /> E.H.,9 2M 1.67 Vanguard Press <br /> , <br /> i' A,, <br />