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I-UK Ut-t-1(—E U5E: <br /> .................................... ..... ............. <br /> .......... ........... .......... ------ APPLICATION FOR SANITATION PERMIT Permit No, <br /> ----------- ..................I ............. ......... Porriplete in Duplicate) <br /> - - ---------1......................... . Th Date Issued <br /> 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 and install the work herein described. <br /> This_a lication.is made.in..compliance,with County Ordinance No. 549: <br /> qp <br /> JOB ADDRESS AND LOqATTON__-/A.... <br /> ------- ................ ...YA <br /> 0(7— 0'90­5�t <br /> Owner's Na ,S, ........................................ <br /> arpe ... ... .. ........ ...................................... Phone.............. <br /> .................. <br /> .............. ............ ........ ....I <br /> Address.......Qft - a �j + <br /> .VA-_Q*A... ...... <br /> ----- PIP <br /> Contractor's Name........... <br /> tt <br /> -- ------ --- ------------- --------A ..... ...................... Phone......----.:............._..._._. <br /> ......... <br /> Installation will serve: Residence 0 Apartment House [3 Commercial PT_'Trailer Court E] Motel El Other [:1 4SN <br /> Number of living units; lNumber of bedrooms Number of baths !�_ Lot size <br /> 1 __ 061--------------------------- <br /> Water Supply. Public system E3I <br /> Community system C] Private E?r""Depth to Water Table ... ft. <br /> Character of soil to a depth of 3 feet: Send C] Gravel F I <br /> ] Sandy Loam[Clay [I Clay[] Adobe C] Hardpan <br /> Previous Application Made: jif yes,1 4 <br /> dote........ -----------) No F-1 New Construction: Yes E] No 0 FHA/VA. Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS! <br /> (N4?wseptic-fink or cesspool permitted if public sewer is available within.200 feet.) <br /> Septic T5Z.- - Distance from nearest well------- ---------Distance from foundation-- -_------------ Material.................. <br /> ❑ .......... <br /> No. of compact ants-.........................Size..... <br /> I -----------------___Liquid dep.th............. ............Capacifl/--------------- <br /> DlsposField: Distance from neare:sf well::?.`4:ft�i4.--D;sfance,from foundation......!_'_.....Distance to nearest lot line....I:r---/ <br /> Number of lines_ ......I.'- h7 o f <br /> -- ----Length each '__..___...•...Width of franc <br /> ....... <br /> Type of filter bf filfer material......Zf�............Total length-,......iA <br /> --- <br /> .................. <br /> Seepaggpff. Distance to nearest well..............___....Distance from foundation-'Diameter. <br /> ' to nearest lot <br /> De Number of pitsJ..4------------Lining material.......S..A.,!.... 2- 'AIS'40. ? <br /> ---Size: Dia meter..j.- .......Depth......A-t <br /> --------- ------- <br /> Cesspool: Distance from nearFst well -4`j; " 'dtion...l - ' <br /> D nce to found ...............1ining material.._-_..._........_.......__......_--. <br /> diameter-• t--------- ------------- ------- •Depth.......................­..... ............ <br /> ❑ Size. <br /> ---------------_----Liquid Capacity............................gals. <br /> Privy: Distance from nearest well__._.- -------- _Disfance from nearest building."......___......_-....._._. <br /> Amw Zal:_vw. . ............... ....... <br /> Distance. to nearest lot line.................... <br /> Remodeling and/or repairing (describe):.._. <br /> .............................................-................(� -, t - <br /> F..............-----------­-------- .............................................. ...........I................................................... <br /> ....................­ ......•-•---.....-- <br /> .......---- .................. ...............­­­­..................................---------------.......................................................................................... <br /> ............... .............­­............................0.� <br /> Is, <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 <br /> ordinances, State laws, and rules and. regulations of the San Joaquin Local Health District. <br /> (Signed)------- .. I <br /> --- ----- ------------------------- ------ --- �,wells, buildings, etc., can be placed an-pbomer and/or Contractor <br /> By............ .. ) <br /> ............. .....................(Title.......... ............ .............. ------- ---------- <br /> (Plot plan, showing size of lot, location of Sys tion reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_. <br /> REVIEWEDBY_........_.. ..................................•..._.......--•-•--•-••-----------------------_---_-----....... DATE._..._........ <br /> BUILDING PERMIT ISSUED......------. •-----.......... -------------------------------1...... DATE_.............. <br /> Alterations and/or recommendations: .......... <br /> .............. .................._----_---- .................................................................... <br /> ...................... <br /> ............... <br /> ..................................­­­....... . ................................. .................­----.--...._•----.--...................................................................................­....... <br /> .................... ......................... <br /> �_­.­............................�­ ­ .......... ............................ ........I......... ................ <br /> ................................................... .;4Z� <br /> ......__ I -- --------...................1-1................ ................. <br /> ..................--...•----------•...................•...._..-- <br /> ---------------* <br /> FINAL ------------------- <br /> ------------ Date--.----- .- <br /> No2ellon Ave. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slockton,California Lodi,California Manteca,California Tracy,CalifaTnia <br />