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FOR OFFICE USE: -------- ------- - ------ - --__-..--_..--.--_----------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No .. _ `..�✓�r - . - (Complete-in Duplicate) -..-.._ ________________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to conrstr ct and install the work herein described. This application is made in compliance with County Orrdiinnance No. 549./ 7`', �!� ` JOB ADDRESS AND LOCATION. ,_IC l-'0�J? ./7J__ _,._�c _L�c_�1i_ 7�7--A-G�v'- a - - ------- --------------------------- ----- Owner's Name__ GZ�SJcP._ /1111�C/'J .p _ �"i --------------------------- ------- Phone_ .- d.,r? �. i Address---------------------------- -- F1,1------ � - Ph_o..n.------------------------- Contractor's Name------- ------------------------------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other � � of livingunits: __ .__._ Number of bedrooms _-----._ Number of.baths-----___.-Lot size _ _/J_ ��77 ` -------------------- Number "� /s�_f .�Water Supply: Public system ❑ Community system ❑ Private 'Ur Depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay roam E]—Clay lay ❑ Adobe td, Hardpan ❑ Previous Application Made: (If yes,date--...... ......... ) No ❑ New Construcf0r,c�YJ Xii ❑ FHA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- � f Septic Tank: Distance from nearest welrl.1�02..._Distancefrom foun --------Materia l .._e _ _-----_________- XNo. of compartments ��------•----- - --Size- _j6*k __Liquid depth� �-r--f---- -- Capacity--• - - ------------ Disposal Field: Distance from nearest well-11-0.0 -----Distance from foundation_J_0..............Distance to nearest lot line_,_ �-—-------- Number of lines___ __ _._ (Length of each line.{ Qll_`_IOP.r..cWidth of trench__,�_4ZZ -'-`------------------ T e of filter material De th of filter material___./. Total length ltL_________________________ Yp - ----- P _ -�-- e-------- g - a See5?aa e Pit: Distance to nearest well-__/4.Q-.'F-------Distance from foundation-,_1(�----------Distance to nearest lot line___ ______.._ Number of pit --- -------------- material--_ 4-G�_ Size: diameter_... s y ` j. Depth---. ---------- o I Cesspool- Distance from nearest well ________________Distance from foundati nt_ _ Lining material-..-_________..___.._.._______.-._.- ❑ ySize: Diameter- -- ----------- -- -----------� .'Depth-.--------------------- -_---Liquid Capacity -------gals. I If Priv Distance from nearest well ____- ----F....-_t_._-._-.----- Ate 4ce from nearest building ___._..._._. ❑ r - Distance to nearest lot line .....- =`- - ' --•-•----- ---- -- Remodeling and/or repairing {describe)----- - - ------------ --- -------- - ------------------ ------ --------------------------------------------------------- -------------- -_.. -- ---- --------------------- --------------------------I------------------------------------ ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------li,�----------------------------------------------------------------------- ----- ---- -------------------- -------------------------------------------------- -------- I hereby certify that I have prepared this application and that the work wi be one in accordance with San Joaquin Count ordinances, s, and rules "flonsS -'..Joa. u' - cal H Itis District:r �C - ------ Contractor(Signed} - - ----- --------f� } BY:----------------------------------------- - - - ----------- -- -�[1� 1 (Title)--------- ---- - - (Plot plan, showing size of lot, location of system in relation wells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ `-_ __._.__.-.- ._. - ----------------- --- -------------------------------------- DATE-- REVIEWED ATE--REVIEWED BY----- ----------------------------- ----------- --- -------------------------------------------- ------------------------ DATE------ ---------------------------------------------------- BUILDING PERMIT ISSUED-------- -- ------------------ - - -------- ------------ -------------------------------------------- DATE----•------------------------------------------------------- Alterationsand/or recommendations------------------ ----- -- ------------------- ---- ---------------------------------- --------------•------------------ ------- ----------------------- --------- ------------------------------------------------ ----- -------------------------------------------------- --- --- ------------------------------------------------------------------------- -----------I---------- -------- ------ ----------------------------------- ----------------- ----- - ---- ---- ----- -------- ---- ------------------------------------------------------------------------- ---------------- ----------------------------------- ---- ---- -- --------- ---------- ------------------- ------ ----------------------------I------------------- -------------- ---- ------ - ----------------------------------------------------------------- -------- --------------------- FINAL ------------------r--------------------------- FINAL INSPECTION BY:..-.V_U-_---------------------r Iri ------ ------ Date--?--------------------------"---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press 1� _