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•1-Uk OF IUt Ust: <br /> -- ---- APPLICATION FOR SANITATION PERMIT Permit No. __..c'_7JA�Z--- <br /> --------------------------- --------- - -----------­­ ------- (Complete in Duplicate) <br /> 1 ' Date Issued <br /> -I ------------------- <br /> - ------------------------------- This Permit Expires 1 Year From Date Issued f �( �1 <br /> i��ioApplication is hereby made to the San Joaquin Local Health District for a permit to construct and i�R'tlSr�ddritbe <br /> This application is made in compliance with County Ordinance No. S49. <br /> . ?I y r` <br /> JOB ADDRESS AND LOCATION_.__M��/_f�ts ---- ------- --------_--•-------- <br /> Owner's Name------. , ----- Phone_..- -•-------- <br /> Address-----------. `�`�`T° . 1`� ------------------_-----------------------------------------------------------y,-- -----2-------------------------- <br /> -•------------------------------- <br /> Contractors Name. f./ r�L q �7 �4'--�---------------- •----------- ------------- Phone--- <br /> -----•--- <br /> t Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth;*� <br /> t 4 Number of living units: ____._ Number of bedrooms .____. Number of baths __._._._ Lot size ` �'!i.4%.____________ ----.--.- <br /> Water Supply: Public system ❑ Community system ❑- Private ' j Depth to Water Table r5 _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam[�] Clay Loam ❑ Clay ❑ Adobe Z Hardpan ❑ <br /> -. Previous Application Made: (If yt3s,date-----------,--------l No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATIOWAND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 240 feet.) <br /> Septic Tank: Distance from Weare ell_�` Dis}sneer from fo ndation__f 0-�-_______.MateriaL�`"�________________________ _ ___:_. <br /> .Ca acit <br /> IV No. of compartment ---- PV-----Saul � ��r� ---Liquid depth � P YA �t' � <br /> A <br /> Disposal Field: Distance from ne rest well;rP-----------Distance from foundation-- _ t7----..--__Distance to nearest lot line.S _.---_-_-- <br /> ]r Number of lines- -_-_--.-__---- --___-____-_Length of each of french....�__11----------------------d <br /> Type of filter materi �� Depth of filter material__/j'...._....._Total length__f '45...____--______--__-_ <br /> Seepage Distance to neaiest w 1___ :___________________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Seep„ A` Pit: Nurnber of Its Lining material----------------------.Size. Diameter-----------------------Depth.......... ------------ <br /> Cesspool: Distance from nearest well-__- .----.-.Distance from foundation--------------------Lining material------------------------ <br /> ❑ Size: Diameter- qu <br /> - ---------------------'----------Depth--------------------- -----------------------------Liquid Capacity----------------------- gals <br />! Privy: Distance from nearest well------------------------------------------------- from nearest building_---.--_---__._--___-------_-.--..__----. <br /> ❑ Distance to nearest lot line-- --------------------------- -------------------------------------------------...------ -------------------- ------------------- <br /> I <br /> Remodeling and/or repairing (describe):----------------------------------------------------------------- <br /> ------------------------------------------------- <br /> G <br /> ---------------------------------••-------------- ---------------------------------------•-----------•-•---------------------•----------------------------------------...-------------------------------- yr <br /> ------------ <br /> --------------- ------------------ ------------- ------------------------------------------------------------•-••---------------------------------------- --------------------------------------------------------------- P <br /> 1 hereby`.certify that I have prepared this application and that the work will be.done in accordance with San Joaquin County <br /> ordinance , to laws—.,and rules and regulations of the San Joaquin Local'Heal#fi District. <br /> 1 �` r Wer Contractor) <br /> y (Signed) ------- ---- -----(Ow and/or tor) <br />' By=--- ----------------------- - (Title)-------------- ------------------------ <br /> [Plo# plan, sho ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> k' FOR DEPARTMENT USE ONLY <br /> r <br /> APPLICATION ACCEPTED ---------------------------------------------------•--- DATE---- I------------------------------ <br /> REVIEWEDBY------------------ -�•--�------------------------------------------------------------------------------------ ------------------------- -------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------•---—-------- ---------------------------- DATE----------------------------------------------------------- <br /> Alterations <br /> ------- -- ----- <br /> Alterations and/or recommendations------------------ ---------------------------------------------------•--•--------------------•-••------------------•---••-•-•---------------- •-----------•- <br />} <br /> ----•----------------•-------------------------------•-------------------------•----------------------------------------------------------------------------------------------------------- ------------- ------------------ <br /> l. i ---------------------•------------------- ------------------------- ---- -------------------------- ------------ <br /> FINAL INSPECTION $Y:_- ^� r� -------------------------------- <br /> ...-._��x;_V� '-r�r.--=m'�:��-.------------------ Date--------------- -------- -• ------------- <br /> I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stocklon,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 3M 3-•63 F.P.CD. <br /> 9 _ <br />