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FOR OFFICE USE: <br /> :7_1�LYT7.41�-—---------------- <br /> ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------------------ -------- (Complete in Duplicate) <br /> Date Issued <br /> ------- --- ----- ----- ----- L 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 /> T is application is made in complian6e with County Ordinance No. 549. <br /> ,Z3 x. 31. <br /> 1 <br /> JOB ADDRESS AND LOCATION--!�/Wee,�----- --------d/ --------------------------------- <br /> Owner's Name-------&- v- ------------------------------------- ----------------------- Phone------------------------------------ <br /> ;�;- -------- ---- - -—------------- <br /> Address................... a g!orif---------- ---------------------------------------------------------------------------------------------------------- <br /> Contractor's Name---------------- <br /> e -- --------------------------------------------------------------------- Phone----- ------------------_------ <br /> Installation will serve: Residence Rae'eXpartment House E] Commercial Ej Trailer Court E] Motel E] Other Ej <br /> Number of living units. __/_ Number of bedrooms ?-- Number of baths o2-__ Lot size0,40'-4 �-­,------------ <br /> <.f-OK---------//f C+ <br /> Water Supply: Public system E] Community system E] Frivate �epfh to Wafer Table 44 t. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam E] Clay Loam 2i"Clay 0 Adobe El Hardpan F1 <br /> Previous Application Made: (If yes,date--------------------) No 92�New Construction- Yes �lo 0 FHA/VA: Yes R;---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 - <br /> --.Material-. -- -- ---- - ------ -- ----------- <br /> ts---19--___-_-__.-..--Size- x <br /> No. of compartments-- Y.XA0_____fex -Liquid dep�h_�_r------------------Capacity/1'7_111_ L <br /> i or <br /> Disposal Field: Distance from nearest well--s ----- <br /> ---- -------Distance from foundation---e-la----_---.Distance to nearest lot line_4�­.__. <br /> Nu m mber of lines----_ 5`49 <br /> ------- ,"Length of each line--ib ---- Width of french.gf--------�0*--------------------- <br /> ----------------- <br /> Depth of filter mafer�a <br /> Type of filter nn,_i I/--- - - -- ------- --------Total length---IP? <br /> Seepage Pit: Distance to nearest well.-: ---=----Distance-from foundation-------------------.Distance to nearest lot line--__-__-------- {/�1 <br /> ❑ <br /> ine----------------- <br /> ElNumber of pits!__il...................Lining material-------------- _-------Size: Diameter-----------------------Depth-------------------------- ------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----------------'-.Lining material_--------_-----------_---------------. <br /> Size: Diametert-_ --- ---------- ------------De th------- ----------------------- - ---------------!-Liquid Capacity----------------------------gals. <br /> Privy: Distance from Irlearesf well-------------------------------------------------Distance from riJarest building.---.-----.-----------_----__..______._. <br /> i <br /> Distance to nearest lot line------------------------------------------------------- <br /> El ---------------- ----------------------------------------- <br /> Remodeling and/or repairing (describe):------------- - ------ --------------------------------- <br /> i # W- t./ ---------------------- <br /> ----------------------------------------- ------------------ --------------------------------------m----- - - - ------ ------------------------- ------------------------------ ------ <br /> "------------------------------------------------------------=- ---- --------------------------------------------------------------------------------------------------------- ------------------------------------------ <br /> - ---------------------------------------------------------------!---------------------------------------------------ro,---r--------------------------------------------------- ----------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> i ordinances, State laws, and rules and regulations of the San Joaqui Local Health District. <br /> ��L I Hea <br /> Contractor) <br /> ............... <br /> (Signed)---------------------------------------------- ---- --- - ------ ---- ---- ---------------------------- <br /> -----------(jgwner aidfo Conf <br /> Je By:------------------------------------------------------------------- ---- -- ------- ------j---------(Title <br /> ----- ------ -------------- <br /> (Plot 'Ian, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). <br /> P <br /> 400, FOR DEPARTMENT USEJONLY <br /> APPLICATION ACCEPTED BY.... - ------------ ----------- <br /> ------ ----------------------- DATE- L-_ —-------- ----------------- <br /> REVIEWED --------- ------r------- ------------------------- ----------:------------ ------------------------------------- DATE------------------------------------------ ----------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------• -•-----------------I------- DATE. ----------- ------------ ------------------ <br /> Alterations and/or recommendations: c---:-=------------_�j i <br /> ---------- --------------- --------------------------------------------------------------------------------------:---------------------- <br /> ----------------------------------------------------------------------- - -------------- ------------- --------------------------------------------- <br /> ---------------- ----------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------- <br /> --------------------------------- ----------------- ------------- ------------ ------------------------------------------------ ------------------------------------------------------------- ------------------------------ <br /> ---------- -------- -- ------- - ---------- ------ ----------- ---------------------------------------------------r--------------r ­----------------------- ............ --------------------------- ---- <br /> 4�,�. ....... ------ Is— <br /> FINAL INSPECTION BY:_ .... ..... ------------------ Date---- -------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 601 E.Hazelton Ave... 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> s4fon,liallfafrila 1 Lodi,California Manteca,California Tracy,California <br />