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FOR OFFICE USE: ...... ...... ........................................... APPLICATION FOR SANITATION PERMIT Permit No. ..�>af? --- -------------------- ------.............._ ---- (Complete in Duplicate) ...... This Permit Expires 1 Year From Date Issued Date Issued `f f e 9 0, Application is hereby made to the San Joaquin Local Health District for a permit to construct.Z-an Instal� e work *rein described. This application is made in compli nce with County Ordinance No. 549. JOB ADDRESS AND/OCAATIO`N1A ^E------------------------- _W .,S_T.ST. -AI- Addr*Ss..._3GOb..___DALSQTCI....E►VES..X.WODE5`L - ----}i7 _-..L-.. .P2c'��.Q.g......1►�R_N.TE a9 .. Contractor'sName..m�-��tALH1D.....�S. P..T{ .--SFrK1Ll.C. ..............................-------._±!........ Phone................... .--•............ :.. Installation will some: Residence I e Apartment House Of Commercial ❑ Trailer:Courf.[j]-Motel ❑A Other [I Number of living units: ../... Number of bedroom,3.. Number of baths ._ Lot size . ...._..._�A..__.._._�G Water Supply: Public system ❑ Community system C1 Private Depth to Wafer Table Yoe. Character of soil to a depth of 3 feet: LSand �Grevel C] Sandy Loam C) Clay Loam[j Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date...� .. . r. / � [I [aY [I) No 93--New Construction: Yes FHA/VA: Yes Ro 'C� .... TYPE OF INSTALLATION AND SPECIFICATIONS: Vl (No septic tank orcesspool iMedtif.pu66c sewer.is available wifhin is 200 fe ) .7. ... .F. . C a GYNSe tic T Distance from nearest walll-.0....Distance-from foundation-. QMiy ' 4RT / No. of compartments.. ...-.... Liquid de + . Z...........Ca aciy..a_-_,r 4A F Disposal Field: Distance from nearest well....6-J......Distance from foundation...A P__,_.....Distance to nearest lot lin..,5....... I� Number of lines......2..... Length of each line.. e�--d.. . _.,Width of trench...s .,?.... d /._'.............. Type of filter material.... 4. 1�'.....Dapth of filter material.....�. .,!......Total length........11D,._....._.._........ Seepage Pit: Distance to nearest well.l..._._......._._Distance,from.foundation.__..._.-_• .._..Distance to nearest lot line................. ❑ Number of pits......................Lining material__--------------------Size: Diameter. ........Depth .......... Cesspool: Distance from nearest well........-------Distance from foundation..._'_' ........Lining material..................................... ❑ Size: Diameter..... . ..............................Depth........ ...!.-. MA... .....Liquid Capacity...........................gals. .' . Privy: Distance from nearest well.-------_................................Ale, r •11 ........Distance from nearest building.......... ❑ ,Distance t'o nearest lo+ line.................................................._....------- ....)....... . . ... Remodeling and/or �....._.. M....F..MJ.tl.Q.�s.9.tJ--•-./Q ....[a '1= fh rJf�i�+.r..�Q. --ih7<= +R°p r..........----.................-------.-----...__.......... r.2:1.?.-.b3..:.....SSP.T!5..._Bg�tc,...L,S----��.-.---��--ri---•---�ocK....AD�D�p-'-�---_.tERSN._..'4__4:.f<_.....TI_S..A.,... I hereby certify that I-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State w .rul and reg raafions of the San Joa_0m Local Health District. .. (Signed J._..__v ..... ... __. +.._ 7. 1. .,.. 1 (Owner and/or Contractor) By:......-................ ------------------.------------..---....-___....:....._.----------..---......._!-.. .(Ti#le).......-................ - --- ............ _............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, efctcan be placed on reverse side}. i i FOR DEPARTMENT USE ONLY A APPLICATION ACCEPTED --------..........-_...-......................._-..•.ATE......... `�..^ REVIEWEDBY........:...................._...... ._... •------------------•--------------------�-----------------------. DATE.tI............................_.._.....•-------...... R\ BUILDING.PERMIT_ISSUED...................... . ..... ........._.....:_.......... - DATE�:_:.r._...:-..- -- Alteretions`and/or recommendations::..... .......................... ':.... -- __. .. --......._.. _ _._._..__.._._....._.-.........._........._.....------- -' ....................................................___............._................._......ary._..__....-:rn{i . .._....._..-........_....._.-...._..._..-----------------......_a i i`mV ----.-.___..................................................__. ...----......._...._........---._...----_-. -....---•--.....I...-.............._--_...._................_..........._......._..............� .. .... --...... ..... .._......................----.----...--'--- ................. , `.-......../_.----.........----"----...........-'----....----......_........_............ Date...--- ...............INSP SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 WeE1 Oak Stme 174 5yceman 5~ 205 West 9th Street 510A en,califemio Lodi,Califomlo Montaca,California Tracy,California E6 9 RCVISSO 0.59 ]M 3-1D3 /.P.CO.