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�4 OR OFFICE USE: <br /> 7 7 A� <br /> k? <br /> ----------- ---------- -- -------x:.UW-14 APPLICATION FOR SANITATION PERMIT Permit No. 12C2 <br /> --------- ----7---------- - ------------------ -------­ (Complefe-in Duplicate) Date Issued <br /> --- --------- --- - ---------------- ------------- - I 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 application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND 07— <br /> LOCATION------- <br /> 14611.1 <br /> Owner's Name------7-Ze.,19 ---------- - ------- -------------------- ------------ ---------------- ------------------------ Phone,_Y_�� -------- <br /> Address.......... <br /> ------- 27-------------------- <br /> Contractor's Name-------- .07 <br /> --- ------- ------r........ --------------------------------- Phone------ ------------------- <br /> Installation will serve: Residence 01 Apartment House E) Commercial [] Trailer Court ❑El Motel ❑Ej Other ❑E],, <br /> Number of living units: --- Number of bedrooms _,,9—__`Number of baths. Lot size -----0 <br /> Wafer Supply: Public system Community system El Private [I Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand [:] Gravel [] Sandy Loam"E] Clay Loam E] Clay [] Adobe 0 Hardpan Ej <br /> Previous Application Made: (if yes,date--- ---- - J No El New Construction: Yes E] No E] FHA/VA: Yes E] No <br /> ❑ <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 /> El No. of compartments-- -----------------------Size--------------------- -----------Liquid depth-. ------ ------- - Capacity-------- <br /> _ ------------------ ------ ------- <br /> ------ -------- <br /> Disposal Field: Distance from nearest well. .-Distance from foundation---/0_/-___._.Distance to nearest lot <br /> Number of lines-------------/ <br /> Length of each line_-_-__ -5-0--1 Width of trench. 3---$/ <br /> Type of filter material------.41_>�r *'--Depth of filter material----ell?----------- -Total length---------------------------------------- <br /> Seepage Pit: Distance to nearest --------Distance from founclafioa.F-�`_............Distance to nearest lot line_ �.......... <br /> Number of pits <br /> Lining material._//_'�'"._ <br /> Size: Diameter__?R_i'._.------- Depth------ --- --- ----- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation___--_...._._____-Lining material-, <br /> El Size: Diameter- -- -------------- -----------. --.Depth--._-_-_..... --- <br /> Privy: Distance from nearest well_________________________ --------- ---------------------------Liquid Capacity-------------- -------------gals. <br /> - -------- --------_.-Distance from nearest building----------------------------------------- <br /> ❑ <br /> Distance to nearest lot line-------------- ------------- <br /> -- ---------------- ------------------------------------------------------ ---------------------------- <br /> Remodeling and/or repairing (describe)___________________- ------------ - -- ----------------- <br /> ----------------------------------------------- <br /> ---------------------------------------------------------­-------------------- ------------------- ----------------------------- ----------------------------------------------------------------------I------------- <br /> ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ ............... . <br /> -------------i--------------------------------- <br /> -s5-;-------------------- -------------------------------------- ------------------ ------------------------------------------------------------------ <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)--- ------ ---- ------ - ----------------- ------------- ---------------------(Owner and/or Contractor) <br /> By.."" __ I <br /> -- -- -- - ---------------------- -------------------------- --- -- ---(Title)----------------- -------- - - -------- <br /> (Plot plan, showing size of lot, Iota i n of system in relation to wells, buildings, efc.,'can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------x--- ---------- -- ----------------- - -------------------------------------- DATE------ 7,1a <br /> REVIEWEDBY - ----------Y---------7 ----------------------- <br /> ---------------- ------------------------------------ ---------BDATE <br /> � ---------- <br /> UILDING PERMIT ISSUED-------- -------- -------------------- ---------------4------------------------------------------.__ DA-TE_. <br /> Alterati,pris apd/or recommendations:------ - --------- ------ <br /> .......Z/4r06-7------VV.4�.-�-------------- -- - ------------- -.-.- <br /> ---------------- <br /> FINAL <br /> --------------------FINAL INSPECT40N BY:. ------------- cell�a <br /> .......----- ---I--------------------- Date-_.......... <br /> ----------------- ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 11.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slockton,California Lodi California Manteca,California <br /> E,H.9 2M 1-67 Vanguard Press Tracy,California <br />