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................. .... ............... <br />APPLICATION FOR SANITATION PERMIT Permit No. <br />........ e. .......... (Complete -in Duplicate) <br />Date issued .5 96 <br />7—..5=/ <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 ;ns+all the work herein described. <br />This application is made in compliance with County Ordinan e No. 549. <br />JOB ADDRESS ......... ...... <br />At D OC TION ... ... ... ..... ... .. <br />V rn <br />Owners Name....-- .. K ------------ ......... ................ ... .. ...................... Phone./..3 <br />Address. ................ .... .. . . ...... ......... . ...... z .......... ..... ...... ... I ....................................... <br />.................. ....... Phon <br />Contractor's Name ....................................... . . ....... $ <br />­ 1-0 ...................... <br />Installation will serve: ResidenceApartment House C] Commercial E] Trailer Court E] Motel E] Other C] <br />X of <br />Number of living units: I... Number of bedrooms _.S.. Number of baths .2—.- Lot size Ire .... 7--de"Ir ........................ <br />Water 'Supply: Public system 0 Community system X Private E] Depth to Water Tololf!1160. ft <br />Character of soil to a depth of 3 feet- Sand El Gravel Ll Sandy Loam El Clay Loam [3 Clay E) Adobe J!K Hardpan E] <br />Previous Application Made: (If yes,date-.' . No 4 New Construction: Yes E] No QS_ FHA/VA..Yes [] No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic I tank or cesspool permitted if public sewer is available within 200 feet.) I <br />Septic Tank: Distance from nearest well .......... Distance from foundation ................ -..Mater;al ..................... . ....................... <br />[]61(j 5ij#gr No. of compartments.... ...................... size --------- .......... ........... Liquid de,�19 11 Capacity .............. ..0...... <br />1 . ........ ....... ........ <br />Disposal Field: Distance from nearest we[I.,*,gV45'_ Distance from foundation... --------- Distance to nearest lot line -Ar.— <br />.......... <br />Number of lines ... Length of each ........ Width of trench...� <br />I i-aterial ---- Total I length. ............... ............. <br />Type of filter material._-...- Depth of filter m <br />__j ' lot line. <br />. ...... <br />Seepage Pit- Distance fo.nearest well..A/G.NC.. 'Distance om undatic'n..—Q..—....Distance to nearest <br />i_ I .... ............. <br />Number of pits..0 -).. Lining material. .... .... Size: Diameter. <br />Cesspool: Distance from nearest well ................ Distance from foindaflon ... .......... . Lining material...................._............_.._ <br />C, 1`11 4. i r% 4 L, I: jA r-1114. 1 <br />-1 <br />L_j ize: iame er . .. ........ . ..... .... I ........... rep ­.. I—— ......................... 'Clu Fu y....---•... .. ............ -ga 5. <br />Privy: Distance from nearest well ................... ............................Distance from nearest building_.. ! .......:I...._.......__...__........ <br />❑ Distance to nearest lot line .... ............ <br />.... ..................................----- ........ <br />Remodeling and/or repairing idescribe):-.-Ci Z 4 0,4. � ....................................... ...... ............................ <br />....................... <br />............ <br />.................................... ...... ............ . ....... . . .... .... .... ............... . ......... . ................................................. <br />.... ....................... <br />............................... . ............ 1-1 ...... I ... . ... I ................ . ......................... <br />............................................................................... <br />. 1 11 F 14 <br />..... I . . ....... <br />.....................................................................••--.---•--.....-----•-•..._------.....--------............................... ....... .. ............................... : ..... <br />I herebyI have prepared application and that the work will be done in accordance with San Joaquin County <br />rules <br />,:, - -San Joaquin Local Health District. <br />ordinances, State w-, a , a regulations of e <br />ru,"tZs .1 , I I - <br />...... * ....................................... ........... (Owner and/or Contractor) <br />(Signed).. ................... .. .. .......... .. . ..... .. . ........... .... <br />By: ....... ......... .. ..... .. . ....... . ............. f ... <br />(Plot plan, showing size of lot, location of systerint.'ineliat�i6K 6'uilcliri*gs, etc., can be place on reverse sidi). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY .. . ........... .... .. ..... .............................. .... DATE. .......... ................. <br />REVIEWEDBY ............................................................................ ................................... . .... DATE....._.........--.------..._. ............................ <br />BUILDING PERMIT ISSUED_ ....... .. TE .. ........................... <br />Alterations and/or recommendations:... . ..................... .. ........ ...................... <br />........... ............................. I ...................... $... ..... ... ...... 1* ....... ............... ......... ........................................... <br />....................................................................... . ..................................... . ............... .... .... ­ ...... <br />...... I ..................... ............... I ..... .. .................................. <br />,FINAL INSPECTION -A <br />_0 ------------------- Date ............. ....... <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 F. Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br />slocklon, California Lodi. California Manteca, California Tracy, California <br />E.H. 9 2M 1.67 Vonguard Press <br />