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FOR OFFICE USE: <br /> --------------4-4-13.49. 1 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> j�------- - ----------------------- <br /> ....... ............ --------------------- (Complete in Duplicate) Date IssuedNe�/­"' <br /> -_------------------ ......... ........... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This applicatioA is made in compliance with County Ordinance No.P9. <br /> oe <br /> K:) x <br /> JOB ADDRESS AND LOCATION., 0 e46_�. .......C;��... ------.4r ............ <br /> ....... <br /> ----------------------I........................................... Pho1e__*. _1Z./6_f 0.3.. <br /> .... .............P i <br /> Owner's Name-------------t"7714__ ...aw <br /> Address............................................. ---I-------- 0..V_.rJ.4........bAJW,4�........................................................................ <br /> SA4 Phone.A9.4 -R 7 <br /> . -(a 6!F1 <br /> Contractor's Name.---- <br /> ?AAALt. . ......V.M-_L__t-----------------------------.................................... <br /> Apartment House E] Commercial [-] Trailer Court E] Motel E] Other [I <br /> Installation will serve: Residence $-' <br /> Number of living units: Number of bedroomi_`.'Number of baths Lot size ----1-2-S.,...................... <br /> Wafer Supply: Public system � Community system El Private%f] ;Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam E] Clay Loam F1 Claj-E' Xdobe 91 Hardpan C] <br /> Previous Application Made: (If yes,date.......... ---------I No EJ New Construction: Yes E] No E] FHA/VA: Yes C] No E] <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-------------------Material--------------------------------------- <br /> E]-gjcc.54-(A4v'No. of compartments-----=-- _X..........Size............................_Liquid --------------­--Capacity....................... <br /> y. <br /> Disposal Field: Distance from nearest well/W-Re.--Re._.Distance from foundation-/iO.-**..,........Distance to nearest lot line... <br /> • Number of lines.. C1_') Lengfh of each line.__f_S�7._tt=7'7__.Width of trench -------------- <br /> ---------- <br /> Type of filter material.-- _"*jtX.Dp+h of filter *....Total length...... .......... <br /> Seepage Pit: Distance to nearest well_-------------------Distance from founclation__...............Distance to nearest lot line...... <br /> El Number of pits......................Lining material__---- ...........--.Size: Diameter------------- .........Depth................................ <br /> Cesspool: Distance from nearest well--------_-__Distance from foundation!......................Lining material..................................... <br /> El Size: Diameter.---..................................Depth--------------------------------------------------Liquid Capacity.....------ .gals. <br /> Privy: Distance from nearest ............._..........Distance from-nearest building.-.-.-_--.-_--.-_.---.-____---.--..-_..._ <br /> ❑ Distance <br /> uild;ng-------------------------------------- <br /> Distanceto nearest lot line-------------------------------•----.------------•-.........---.........................................---....•.........--•-•-.......... <br /> Remodeling and/or repairing (describe):---- ---- ----------- -----------------• ------------11------------------------------------------------------------------------ <br /> ........................................................................ ... .........4 -----A--- 1�-- -- ---- ---- ............................. ...... <br /> .............................................................................................................................................................. ............................................................ <br /> ------------------------------ . ..--•••..................................................................­­­.............--------------­---- ........................................--------- ------- ------ <br /> I I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> `ordinances, Late laws, an and regulations of the San Joaquin Local Health District. <br /> (Signed)------------------- ------------�(: <br /> ...... ..................... <br /> ..�_k t ----------------(Owner and/or Contractor) <br /> -- ------------- <br /> - ----------- -- <br /> Z <br /> By:............................. ......I_ -------- -- ------------------- <br /> /�_�A_ ---- --------- <br /> (Plot plan, showing size of lot, Ircation of system in relation to wells, buildings, etc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.. 0 <br /> ­------------------ <br /> ------------------------------------- DATE_`_,... <br /> REVIEWEDBY............................................. .............................................. ........................ DATE...................I...................................... <br /> BUILDING PERMIT ISSUED..............................-_----------_---_--------_.. .'.. DXTE_------............-•----•--..........-•---....---•---•-•-•. <br /> ... .------------------------ - <br /> Alterations and/or recommendation j:--...................... ...... -------------------------------- --------------------*.........*,-*,*"**............ <br /> ---------__--------------- - --_-------­-............................................................. <br /> ............... ------ <br /> -..---•......................................,­­..............................­..........­...................... <br /> ...........I........................................................................................... . .............................----------------------------........................... <br /> ....................................................................... ..................................I--------------...............­..............................................................­------- <br /> --------------------------- <br /> FINAL INSPECTION BY:......cc.�.;e.............................................. Date--.- ...........1.----.- .... . <br /> SAN JOAQUIN-LOCAL HEALTH DISTRICT <br /> 1601 F.Hazelton Are. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stocklon,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />