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F <br /> a ' <br /> r- <br /> S APPLICATION FOR SANITATION PERMIT Permit No. /101 . <br /> (Complete in Duplicate) y <br /> Date Issued <br /> ti <br /> Applica+ion is hereby made to the San Joaquin Local HRelih Dis?rict for a; nit f construct and install the work herein described. <br /> This application is mode in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND CATION... CG'. r '] :r <br /> ..., .�.........� j.�.y.�..... ........... ....:..Phone.................:............... <br /> Owners Name......p!.-..�--S,a, ..... 111,1 ............ . ............. .................... <br /> :~ <br /> Address <br /> .............1111..-X7......1....:.......... 1111 1111..-'�•:...... .................................--•--................................_.........................1111..--------•------.......... <br /> Contractor's Name.................................... ........ ..... ............................................................. 1111.. ............ Phone........................_......_... <br /> 1 #~f Installation will serve: Residence A erimen+ ..use Commercial Trailer Court Motel Other <br /> •;a, P ❑ <br /> Number of living units: ........ Number of bedrooms ........ Nuniber of bees ..�... Lot size© L..................... <br /> -.... <br /> 1111..... ........_1111.. <br /> GZtJt--E'C <br /> AV' Water. Supply: Public sysf6. El Community system C1 Private �� Depth to Water Table .� ft. <br /> a1 �r <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel❑ Sendy Loam❑ Clay Loam❑ ,Clay.❑ Adobe Hardpan❑ <br /> „ . <br /> Previous Application Made: Yes ❑ No & New Construction: Yes [INo <br /> am <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .,klv (No septic tank or cesspool permitted if public sewer is ayeilable within 200 feet.) <br /> . 1111. <br /> Septic Tank: Distance from nearest wall.................Distance from foundation....................Material.....................1111....................... <br /> a. <br /> No. of compartments............ .............Size........................*........Liquid de;�,th..........................Cepecity....................... <br /> �,;•y��f Disposal Field: Distance from nearest well.................Uistance from foundation....................Distance to nearest lot line.................. <br /> '�f'r ❑ f lines b <br /> Numer of ..................... <br /> ..............Longth of each line..............................Width of trench....................,.............. <br /> ....rte. ... Total len th........................................... <br /> "Ar <br /> Seepage Pit Ty�ance tloen asst,wl©11.:.:=J Q..........D ileo!effromr maser�o Di>srnz rr... t <br /> +�/,� <br /> D'stance to nearest lot line....31/...... <br /> „< <br /> � f�y/�/ <br /> R <br /> � 6er of pits......1..............Lining mete ,a�Ct .T...'l.fa•A..S.Depth...........2 <br /> .,.. <br /> ” Cesspool: Distance from nearest well.................Distance fromEnclation..................Linin material...................................... <br /> 0 Size-. Diameter......................................Depth....................................................Liquid Capacity ........................ gals. <br /> •Y Privy: Distance from nearest well................................................Distance from nearest building..................................6....... <br /> ❑ Distance to noarest-10 line............................................ . ............................................................................................. <br /> Remodeling and/or repairing (describe)%-!.............W........................ <br /> .............................................................................................................. <br /> ...11.11.......... <br /> k<' ......I....,.. .............................................................6..............................1.........111-.......... ................... ............................ <br /> ..................................................................................................................................................6........................ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ' ordinances, State s, and rules and regulations of the San Joaquin Local Health District, <br /> , -'r <br /> G ....,..(Owner end/or Contractor) <br /> (Signed)..:.__.. .. ....... G-......... <br /> By:.....................................................................................................:..................I...........(Title)........................__...........6......................... <br /> (Piot plan, showing sire of lot, location of system in relevion to wells, buildings, etc., can be placed on reverse side). <br /> Soh" <br /> R., FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.............. DATE..-................... <br /> "r ....1......111 DATE...... �.�. ................... <br />} 4th REVIEWED BY.....................................................................(........ 1111... y- <br /> :°.vr, BUILDING PERMIT ISSUED.......................1111. �1 Q ......-........ A .............--1111 <br /> , . <br /> Alterations and/or recommend aticns:..................................................................................................................................................... <br /> ....... <br /> .................................... <br /> ...........`.......... . ................................. ... ...... . <br /> ........11...11....-............................................ ........-................... <br /> { 2 ,S <br /> FINAL. INSPECTION BY:....... ... ...:.�tc�,��....... Date..G'.......<...... ........�...... ..._................................. <br /> ' �... 1111. 1111.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Sout?, American Street300 West Oak Street 132 Syumere Street 014 North "C"Sheaf <br /> S+oel+on. Calitornie Lodi, Callornia Manteca, CANCrnla Tracy, California <br /> �n—p ,away wr wodo <br /> r <br />