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r.. APPLICATION FOR SANITATION PERMIT Permit No. <br /> -- - (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work-herein descr ed. <br /> This application is made in compliance with County Ordinance No. 549. j <br /> > 1 <br /> JOB ADDRESS AND LOCATION. . a �= <br /> Owners Name------------ <br /> -------_ <br /> � r <br /> ... . .. Pteho,n-e <br /> Address ° �. <br /> tfi �= �/ r <br /> Contractor's Name------ --- -`_ .. --�----�- --=----------------•-,- <br /> -------- <br /> - - ---- ------- -------------------- - - -- Phone------ <br /> Installation will serve: Residence Zj-''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: JNumber of bedrooms ._9_ Number of baths J._ Lot size .-... . <br /> ! , <br /> Water Supply: Public system ❑ Community system ❑ Private 0/6epth to Water Table 710. ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay n- Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date- ) No Wr" New Construction: Yes V]=—No ❑ FHA/VA: Yes Z---No ❑ <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 <br /> -•- <br /> > <br /> ag 'f ----.Material . r� .- `��: -------------- <br /> No. of compartments- ey.______________ _Size.`'Y---_�4'X_--_ .>!,�Z�.Liquid depth.- _�. --_--_ Capacity../-./ <br /> Disposal Field: Distance from nearest well. t` 1.....Distance from foundation_. _,,�)'.- ...Distance to nearest lot line-.-:�'..______._ <br /> Number of lines ._-_A.------ Len th of each line-- . ..',. _-_.Width of trench.. �_______________ ___'____ V <br /> r, 9 ,ILS <br /> - i ,- r <br /> Type of filter matenaI_4 .. . Depth of filter material...-✓.: .....-_..Total length_.-.� e-------------•_-__-- <br /> Seepage Pit: Distance to nearest well.. eYl!--.._.-Distance from foundation-__. _ <br /> - �__.___..Distanee to nearest lot line-_.-�._-____.__ <br /> p _-_--Lining material.A. '•'- . C� Size: Diameter-.,3.­ -`-`---_- Depth.,y�. - - ---_-_-------- <br /> .. ��" Number of pits_,2 � <br /> Cesspool: Distance from nearest well ._.._ ----------Distance from foundation _..._ _._--. ..Lining material..._------ ---------------- ----_ <br /> ❑ Size: Diameter. . - -- Depth...----- _ ... - - ------- -------Liquid Capacity-------------- -------------gals. <br /> �- Privy: Distance from nearest well----------------- ---------------- ---- ......Distance from nearest building---------------------------.-_---._.--... <br /> ❑ Distance to nearest lot line ---- ------ - - ------------------------------ --------------- ---------------------------- ---- ------- <br /> Remodeling and/or repairing (describe):. t - >_ - fie j�f ' t� l "- -------------------------------- ------- . <br /> - --•----•---------------------------------•----------•--------••------------•----------------------------•----•--•--••-----•-- --------•--------------------------------------------------------------- <br /> ----------•--------------------•-----•-------------------------------•-••----- --------------------------------------.......------------------------------•-- ---------•---•---------•-----------•••-------------- --- <br /> L ---------- ---------•------------•----- -----•------------------------------- -----•--------------------------------------------------------------------------------------------- - ... - <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> Si ned - ------------ - - -- -- ---9 ) - ��{--- �--"'--- �s}-�J- --- <br /> �+�-a�-----;;; --- -�---- - - - - - - _(O �.r„�nn�or Contractor) <br /> (Signed) <br /> - <br /> BY:------------------------------- ----------..._------------- ----- ---- � �-<�,����- '.. .--��'------------ - -(Title) <br /> (Plot plan, showing size of lot, location of system in rej ion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........ - ---------- --- ------------------ DATE.-. <br /> ---------------------------- <br /> REVIEWEDBY---- -------------------------------•----- - -------------•--•-•----- ------ DATE.......... - <br /> BUILDINGPERMIT ISSUED---------- •---•-------------------------------------------------------------•---------------•------- DATE--------------------------- <br /> Alterations <br /> - ----------------------- <br /> Alterations and/or recommendations:...--- -------------- ........ ---- ----------••----•-----•------- <br /> ------ -- -- ------ --------- -- --------------------------------------------------__----------------------------------- -----•--- ---- -••--............................... •-••-----•-----•--------------------- <br /> .---•------------------------------.................... ............................................... . - ----- -- - -------- ............................. - ---- --- - --•------ ----•--•--------- <br /> ------ ---- ----- - -------- --- --- ---- .......... •-• - .._ .....-........_.-_ .................. _ ----- --- -- ------------------------- <br /> FINAL <br /> -- --------•------------FINAL INSPECTION BY: ' 'T' _ Date .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT -- <br /> 1601 E. Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slockton, California Lodi Californie Manteca. California Tracy, California <br /> E.M.9:M i-h- Vanguard Press <br />