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FC)R OF CE USE: <br /> , rim-............. - K If <br /> 1-r? APPLICATION FOR SANITATION PERMIT Permit No.!Z.,7..91 <br /> .... xll:�, <br /> ................ .......- ...................... L— -.1 (Complete in Duplicate).- Date Issued <br /> ....................... ........ ....... j'This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct al the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. (0 r-7,7 re"o,/-;6�x :s7/,5 <br /> 3 2-1;10 <br /> JOB ADDRESS AND LOCATION.aff...F...rn.......... <br /> /?*-(----------------- I--------- <br /> Owner's ..... ........ .....I...........----------------------------------------:......I.,...... ................. Phone............--------.............. <br /> Address------------------ ........----•--.._...-........................................................................................... <br /> Contractor's Name.....4a,.1 ?4...`J-:..T---v'.........................---.................................................... Phone-----.....---=.................. <br /> Installation will Serve: Residence [5�Apartment House 0 Commercial [] Trailer Court 13 Motel 0 Other [I <br /> Number of living units: .....{.. Nuinbir of bedrooms -13- Number of baths Lot size s3.!!-P... C.............•------:--- <br /> Water Supply: Public system 0 ColAnmunity system 0 Private 23-15apth to Water Table A.4ift. <br /> Character of soil to a depth of 3 feet: e Sand [] Gravel [] Sandy Loam EI Clay Loam [I Clay 0 Adobe&-ila'rdpan 0 <br /> Previous Application Made: (If yes,dote...:.. ............I No EJanNew Construction: Yes R5- No [I PHA/VA: Yes 87-90 C1 <br /> I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) r <br /> Septic Tank: Distance from nearest well-%-Ird...'g'-'Distance from foundafion.19........----Material.. ...... ...... ......................... <br /> 0No. of compartments......2---.......... clepth-...4...... ..........CaPaCity..j.-.Z!,;;0xCr,;-f <br /> ©/ <br /> Disposal field: Disfance from nee I rest Distance from foundation.AV._'......-Distance to nearest lot lin-1-1............. <br /> LY Number Of lines---!A............ . ........Length of each line*..K ..................Width of trench ............... L <br /> Ty0e.of filter mateirialf..KWJ�---..... Depth of filter material..J.,r---------------Total length....J.d.19.......................... <br /> I I:r , <br /> Distance to nearest lot line: ...... <br /> Seepage Pit: Distance to nearest well-10.0-1-----...Distanee-irom foundation ......... <br /> Number of pits...L..............Lining materiA101f -----Size: Diameter.... . Depth.. f...-............... <br /> Cesspool: Distance from nearest well.................Distance from foundation............-.......Lining material..................................._. <br /> ❑ Size: Diameter.- ...Depth...------..... ..................................Liquid Capacity_....- ....................gals. C <br /> Privy: Distance from nearest well..:.............................................Distance from nearest building...............----------------........ <br /> 0 Distance to nearest st lot line..............................................-..............................................................................:.......... <br /> Remodeling and/or repairing (describi.j:----------------------------------............................................................................................................ <br /> I <br /> ---------_---------------•---.........•---.......... ------. ----•-------­7.......--...................................................-..........-........................................... <br /> .................................................................................................. ------------------ ..................... <br /> jr! *.................--------------------- <br /> .............. ...................I............................................................................... ---------- ............................. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I <br /> ordinance$, State laws;,andI and regulations of the San Joaquin Local Health District. <br /> u as a r <br /> Sk <br /> (Signed} - 7Z <br /> I ------....... ......................... L...--'---......------- .................!!..�'.qOwner and/or Contractor) <br /> ..............I;Z� <br /> .......... <br /> By ........ ......Y <br /> L . <br /> . ...C.4....... .. . . ... . ................................ .........-........(Title).---...................................----- ----------- <br /> (Plot plan, showing sure of I*+, location of syst in relation to wells, buildings, ate., can be placed on reverse side).. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. .. ... <br /> .. .... .. .... .. <br /> ........--------................... .................... DATE---'. .... <br /> . . 7..............2 <br /> m........... ........................ <br /> .... <br /> REVIEWED BY------- ---------------------'1............----......---...................................................*...... DATE...................................... — .......... <br /> BUILDING PERMIT ISSUED.. ... °:........................z.- ............ <br /> ...................................... DATE.----------------------------------- <br /> Alterations and/or recom endaf ions:............................ ........ ------------------------------- ------L................ <br /> P7 , "".::----:-�;--------------- <br /> ...... ... ---- ....... ................................................................. <br /> .................................... ...................... ............... <br /> ...............I-............. <br /> ............................................... ............................................. .......................... .................. ....................--............................. <br /> . ........................................;..................................................-...........-............................. ............................................. <br /> ....................... <br /> .... Date.............77 <br /> FINAL INSPECTION BY4 ....................................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hattelter,Ave. 300 West Oak Street 124 Sy,.ona,.Street 205 W.,t 9th Street <br /> Sto.ki.r, California Lodi,California Monfeca,California Tracy,California <br /> Its 9 REVISED 11-59 3M 3-'63 <br />