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OFFICE USEI <br /> Permit No. <br /> t�Iffj�k: ........................ APPLICATION FOR SANITATION PERMIT <br /> Date Issued ... <br /> .............................. (Complete in Duplicate) <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. 06 S- /00- 24 1 <br /> ita _"6 1tF:.-j=A424"_ ". jtco�) <br /> .... -----. . ....... C.- -A <br /> JOB ADDRESS AND LOCATION TA111-1- go- / 649- <br /> Owner's Name----.----.. /---- ------ ­---- ------------­­............ phone-_ -7--37_�04_ <br /> -----------­--------------­----------- -----•"------ <br /> Address--------------------- 2'-----......2&x------ ..........Z_ <br /> Phone__ XA.....VAA19 17 <br /> Contractor's Name................. ...... e ................................. <br /> ...__........... <br /> Installation will serve: Residence & Aparfment House [I Commercial E] Trailer Court 0 Motel C] Other [I <br /> .. ie <br /> Number of living units: ---L Number of bedrooms _ j._ Lot size ...... eV ". .d— <br /> .I-Number of baths pef --------- <br /> Water Supply: (Public system 0 Community system 0 Private ffro"Depth to Water Table ........ It. <br /> Character of soll-faa depth of 3 feet: Sand E] Gravel [I Sandy LoamO Clay Loam[Clay 0 Adobe[3 Hardpan <br /> ❑ <br /> o [yam New Construction: Yes [I No [41�<HA/VAI Yes [] No CT-� <br /> Preview Application Made: (if Yes,�Gte........._1........) N <br /> TYPE OF INSTALLATION AND'SPiCIFICATIONS: 200 feet.) <br /> (No septic tank or cesspool permitted if public sewer is available within <br /> 01 <br /> Septic Tank: Distance from nearest Distance from foundation... ... ---------eOA <br /> No. of compartments--------- -- Size.... depfh..... _-.-....--Capacity... <br /> Disposal Field: Distance from nearest well_- Distance from foundation..—?,S.. ...Dittance to nearest lot line..,Z:572? <br /> I j Length of each line.....fo ...........Width of trench...... <br /> ai_.� Number of lines --- ----------- ....Total length...... <br /> .Iiii­e'e epth of filter <br /> Type of filter me eria erb <br /> foundation......r4o........Distance to nearest tot line- <br /> ....... is ance r7m To <br /> Seepage ;�,S. <br /> .,Pit: Distance to nearest well--;-/tW---' Di t I Size: Depth �VZS_-' <br /> LSA- <br /> Number of pits... : Diamefer..Z..4 <br /> -Lining r ;?I .... � 611__ ­ .. ------------ <br /> 11 <br /> I - r ion..-----------------Lining material------------------------------------ It" <br /> Cesspool: Distance from nearest well_.:............Distance from foundat Is. <br /> f_1 Size: Diameter..----........ -----------------------------------Liquid- .Capacity...--------------------ga <br /> Privy: Distance from nearest well...._-_...._..._.--..---------- .....Distance from nearest building.___..-----..------------ ......... <br /> ............... <br /> ❑ <br /> Distance to nearest lot line--- .......... -------------------------------�_;; ................................... <br /> Remodeling and/or repairing (des�ciribe):------ /'f&e-------- �+ ,0.e..#rt-- ------ <br /> -it.............. <br /> - .... ----- -------------- ---------------------------­--------------------------------- -------- <br /> ............................... <br /> ---- -- ---------------------------------------; -----------------------­ .... ................................................................... ------------- --------------------------------------------- <br /> ------ ------- -------­--­------­--I ...........--- ------------------------------ ............ ------------ <br /> ...............................................­ --------------------------------- <br /> - <br /> I hereby certify that 11 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and regulations the San Joaquin Local Health District. <br /> ations; of <br /> .............. r /or Contractor) <br /> (Signed)--------------_--------------------4 1 <br /> ------------------- -mile).... -- ------------------ <br /> .............� ., --- <br /> By:........................... ... ..... ]. <br /> (Plot plan, showing size of I location of syste in relation to wells, 6ulldings, etc., can 69 placed on reverse side <br /> FOR DEPARTMENT USE ONLY <br /> ............................. DATE--- --- - ------ `------------- <br /> APPLICATION ACCEPTED BY..... ....................._.. `"-,r------'------------.-...- <br /> --- ............... DATE--�---------------------_------------- ---------- .... <br /> REVIEWEDBY...._1------- -- ------- I.........Z....................­­­------------7,....-- <br /> IDATE_------------- ------- <br /> BUILDING PERMIT ISSUED-------_----_ ...............i............................ <br /> �y--------------------------- -C.--tcr .. . ...... <br /> Alterations and/or recommendatio6s:.......... P.4----I.-- .....r .. <br /> ....... m-._ . _.. , , - <br /> 6 f— ...... . .. ........ <br /> 1_77-1 Jr------ <br /> _X.. ------ ------!........C........ -------­ ".. ..- <br /> f <br /> . .... <br /> -------- ...... ----------------- <br /> ........... ---- -----;l;---- --------...... 1! <br /> eI __4.... .. ... ............ ...... <br /> .............45--1;1---- -- ------f...... ... . . .....­.. . . ......................................................... ------ <br /> --!3r!i. .. .......... <br /> ......................... ------ .............. <br /> . ....... <br /> z� <br /> .......... ...... <br /> FINAL INSPECTION BY:.. <br /> ------------ ............... ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naulton Ava. 300 Wart Oak street 124$Yo.mal-Stl--t 205 W.0 91h Street <br /> si.ckto.,California Lodi,Califaml. Manteca,California Tra.,California <br /> r P.cu. <br />