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F R OFFICE USE: , - r APPLICATION FOR SANITATION PERMIT Permit No.°•__��.�� _ - f�_. j .__------ -_- (Complete in Duplicate) ------------------- �' e--------' - ._-___- 'l-- Date issued 1This Permit Ex ires 1 Year From Date Issued ,__.__._J _ra );j�plication is hereby made to the San'Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in cam ance with Count Ordinance No. 549. JOB ADDRESS AND CATION �i -_/!G�',04 /V. •Ivy,:-- � �v-"/----flak 'r ----------•------------ Owner's Name QJ ------(.f_ [ - Phone Address------------- / _ Contractor's Name----------- ---- --� �..�- -f�----,----L - ------- -- Phone' . Installation willserve. Residence ®-`;�partment House ❑ Commercial ❑ Trailer Court ❑ Motel +❑ Other, ❑ Number of living units: __1__ Number of bedrooms I--_ Number of baths __ Lot size __/_7 _X_ P ____________________ Water Supply: Public system ❑ Community system ❑ Private ❑s`'depth to Water TableqC?__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑- Previous Application Made: ;(If yes,date..............._---) No [R' New Construction: Yes d-lo ❑ FHA/VA: Yes ❑ No ©� I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic T nk: Distance from nearest well-__!ah__--_Distance from foundation-� __�_____.Materiai_�� !4!!�r No. of compartments_____- ___.._-.-_.Size-_ a:_op6�_-&_:__-Liquid depth_,. �ix.`�.........Capacity-ZZO----------- � I DisposalField: Distance l from nearest well... ©p-----Distance from €oundation_15_� ------ Distance to nearest lot line-_.5!-------- 74� of __ - J .. ' ,.Number lines________ _______ _ ____________Length of each line----_&4�. _. _�ONidth of trench.___-r:2_`'�--------.------ ."- Type'of filter material ��`�f(..__Depth of filter material__./ ...............Total len th-.--_ _ g Seepage Pit: Distance;'to nearest well Distance fr foundat�On___. rn! Distance to nearest lot t� ------Linin - , ----Size: Diameter.__�-�•t" __--._.Depth...�r 51-1-- ----------- -- Number of pits___�______ g material___ Cesspool: Distance"from nearest well ..----_Distance from foundation--------------------Lining material----------------------__.-_"--....- ❑ Size: Diameter- ------------------------------------Depth-----------------------------------------------------Liquid Capacity-_-----------------------gals. Privy: Distance from nearest well------------------------------------------ __..Distance from nearest building----------_"_..._--_-_----_-_---.._____-- ❑ Distance jo nearest lot line-------- --- -- ------------------------------------------------------------------------------------------------------------- - ----------- Remodeling and/er,r•repairing (describe):--- -jL� --- �--'/z ----- . �': � � --------------------------- ---------------------------------------- I 4,. ,, _ - -------------------------------------------------------------- ;i t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staws, an "ules and regulations of the San.Joaquin Local Health District. (Signed)--------------------------- ------- -- --- r _/ ..f /..y.. rector Cr - w and or Cont By: (Title)---- (Plot plan, showing size of lot, loca n of system in relation to wells, buildings, etc.", can be placed-on reverse side). ; FOR DEPARTMENT USEONLY r.i kt' APPLICATION ACCEPTED BY P-11 ` -------------{---------------------- DATE-- __11s ---------`---------- REVIEWED BY-------------------------- ------------- -- ------ DATE--------------------•-- -- -- ---------------•----- -------------------------------------- -- -----•-------------------:.:----- , t BUILDING PERMIT ISSUED --- --- g�/ S �._�_ " _- DATE ISSUED-'i __ Alterations and/or recommendations::"--__r//.__._ _____.._ - �Z ;i i ��'� ------=---------------•-------------------------------------------------------------------------• -------`------------- ------------------ .----------------------------- ------------------"__ ._.______..._._...._-._ - 3 --•---------------------------------------------!--------------------------------------------------------------- -------------------------------------------------------------'-----"------•--re-."-_.--------- 4 'I - ` ------------------- Date / .•. FINAL INSPECTION BY:..- --------------------------------- li SAN JOAQUIN LOCAL HEALTH DISTRICT �i 1601 E.Hazelton Ave. . 300 Weit Ook Street 4 Sycamore Street 205 West 9th Street - '- --- -� Lodi,_California - _, Mant_e_ca_,California Tracy,California�Staeklon;California -,� .. .� � it .r ,� ...� '�•`-=•---�� - �� F:P,�CO. � � _