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less ..................--------.-... .__...... . APPLI ATION FOR SANITATION PERMIT Permit No. ...... ................. ._....... ......... (Complete-in Duplicate) � �m - - - - - ............ -- . -... This Permit Expires 1 Year From Date Issued ��7 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ,his application is made in compliance with County Ordinance No. 549. B ADDRESS AND LOCATION ^ %: - ' -_ y .wner'sName.... r.Lr'.......-. 'G-. /:....C•� _______ n (dress.......... --------��r��--d[t/.E7-.- �Y t/..... - d-12 rc �ntractor's Name------ t.^ri.cc--••-----•--------- ------------------------ -------- ------- --.. ------------------------------------------ Phone.----- ...--..-`-- Installation will serve: Residence * Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ LNumber of living units:/ ..... Number of bedrooms ...4�-. Number of baths I...... Lot size ..... ?.-C !^„t„....._........................ ater Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ------- ft q erecter of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ 4vious Application Made: (If yes,date........ ..... ._ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank: Distance from nearest well........j'.__...Distence from foundation.. J V dS-- Material. No. of compartments._..:--.............__Size3..::.--- Liquid depth-:L..... ....... _..--- Capacity..;-:- _.. `posal Field: Distance from nearest well.�_U...........Distance from foundafT* n.t�°.............Distance to nearest lot line............. ® Number of Iines..2r:..__.......................Length of each line_Lgr?...................Width el '-nnch .--------- Type of filter materia( } :...............Depth of filter material--- length:% - .-----. .. - ---...._...-.------ rf •-_•-_-- , `page Pit: Distance to nearest well......................Distance from foundation......._...........Distance to nearesfi lot line.........--...... ❑ Number of Pits... ......-..........Lining material...............------- Size: Diameter-----------------------Depth.......... ..............-....... v=%spool: Distance from nearest well................Distance from foundation_.------------- ..Lining material................................... ❑ Size: Diameter. .. .............. ................Depth.----.... ... .. .-.............-..-.....------. - ..---.Liquid Capacity---- ----------------.._gals. /Y: Distance from nearest well........ ...............Distance from nearest building.................................... Distance to nearest lot line................. � . - modeling and/or repairing (describe):__.._:=_:�.".,•.:..::::e..;...�..4:.:��":_�:_::'_`..:'..:::ri....................----`-'---------•-----------------..... --. ..---------••..........................---...------•-------------...---•----....----•-----------------'-•----•--------------'--`----......------`----'-- ............... ------------ ........................•----....---------------------------- ----- _.......-_...\V r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County lydinances,/State laws,' and rulesandregulations of the San Joaquin Local Health District. r,ied)...... 7.ia L:r �ti r ...tJctk� _mss -�i(.............. -. ... .(Owner and/or Contractor( By:...............-.................................... Title 'I plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY %1 LICATION ACCEPTED T_ -----._.... DATE....`--------4:2-----------.............-•--....... r.EWED BY. .... --- .•----..............--- ---.................-----------.....-- - --------............... DATE L„ DING PERMIT ISSUED........................ -- ------•-----------------------_..............._.......-....----.... DATE-.._--•------ ----- -- ....----------_-_. tJ rations and/or recommendationst........................... ---- ---------------- ---- --------- ----- -----.............-------- ----••- - ...............................- ....................__..... -_....._.._ .. -•-----••---•-•-....--••••-•--------••........... ........_._...._......_.-_....-------.. FINIAL INSPECTION -- ..._. Data..........�............................. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haedten Ave. 300 West Oak Street 124 Symmore Strut 205 West 9rh Street Mackie., California Lodi California Moh nca, California Tracy.California 2M 1 67 Vanguard rd Press