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SE:-- FOROFFICE USE- ------------------- --- ------------- ------------------------------------- ----------_':--------------- ----- -------------- ----------------------------------------------_:---.__..--.--___--- -__-.---_----. APPLICATION FOR SANITATION PERMIT Permit No. -- ------------------- -----------_------- --- (Complete in Duplicate) This,Permit Ex fres 1 Year From Date Issued Date Issued E >t x Application is hereby made to the San Joaquin Local Health District for a permit to,construct and install the work herein described. w This application-is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_--, 1 - -----/` AHJ----------5 _-jW-------- --------------------- Owner's Name - { _ R. A - _------- -------------------------- Address 1.A _ - -�.:.. Contractors Name-` E ,f}l1LT1.- 1 ------ kV"1 G- --. _ • , f ❑ `•Residence Apartment�� ,• �. . �Trail- -------- --c----- Phone. _ Installation will serve'= House'❑ Commercial e Court ❑ °ivlotel ❑ Other ❑ + Number of`living units{�'- Nu b rf be#rooms!'":- Number of baths Lot size1 --_ ! 1 Water Supply: Publiti c systemY❑ Communit s stem Private IY y� ❑ (Dept to Water Table Character of soil to a depth of 3 feet,' Sand'VK `S +-dy Loam ❑ Clay Loam ❑ Clay. ;Adobe ❑ Hardpan ❑ Previous Application Made: {If.yes`,'-date _.y ""---. -.�wNo�'. .- New.Construction: Yes . o [ , FHA/_VP,:.Y-es❑ N�_ � TYPE OF INSTALLATION AND SPECIFEC TIONS: r (No septic tank or cesspool permitted ,f public sewer is a vailable`within, 200 feet.) " Septic _Tr/�G� Not of compartments.Distance from' nearesf Well --- .Distance from foundation �__---------- -- Material-: I ��1 .- a - Size__- Liquid depth ----- ----- Capacity--------- -- --- ----- k. / ----- ------- --- ,-N'4 Disposal Field: • . Qis#once from nearest.well ---D fa'nce from foundation---_!_-0---. .._Distance to,nearbst_lot line_--15 1'1� N�imber of lines_ - £-- --- ----Length of each linetrench g /�. -.-- - Width of - f �}- p Type.of filter material---Ro d�) `Depth of filter material_.-_---�-s_--�t Total lengt�„ ��?Q Seepage Pit: Distance to nearest well -_: -- Distancefrom founds#ion---___-_.- r � ❑ Number t its-- . -----.Distance to nearest lot line -- --Linin " J�F ' i p gymaterial "" Size: Diamet�r. Depth i Cesspool: Distance from neares# ell------ -. -._,_Distance-from fOundat on -_..Lining material.-" 3 --------------- ❑ Size: Diameter------� i - --- ---- - Depth------ --- -" --- 1-----Li Liquid 'Ca aci. ' 1 i I 9 p ;Y -= = gals. Privy: _. Distance from nearest vwell___-- --- _. m: _ _,-_Distance'.from nearest building Distance to nearest lot"line.. --- ------------ ti -••--- ------------------ ----- -" I-- r # � Remodeling and/or repairing (describe) t t� n�x t --- -------------- - . ----------------- -----------------•------------------ ----- ------------h--- ------------------- -___-„_--_-_-__----- _---__----------_'.---- ! _ __ _-____-----_-__ --__---- - ere y cer 'fy that I have pre.pa�ed this application and that the .work will be done in accordance with San Joaquin County ordinances, to laws, and rules regulations of the San Joaquin Local Health District. r. _.{Signed)_ {Owner,and/or Contractor) -v BY --------------- ------ ---- •--------------- -- (Title)----------------- (Piot plan, showing size of lot, location of system in relation to•wells,4bulldings, etc., can be placed on reverse side). s F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----a- - -`------------------------------------------------------------ ----- DATE-- --�---=J REVIEWED BY -------' j------------------------------------------•- ----- --- DATE-- ' BUILDING-PERMIVSSUED"__,__ ` --------------------------- •--••--- -------------------- t Alterations and/or recommendations T � ,_ -"" .x. ' '�'”' "'"� :"'~~"'�"'^•- "` � -•^��=•---' '�--'ter•= P ------------------------------------- - ------------------------- -- -------- --------� R 1A P- -------- -- -------------------- ------------------ -------------- ------ --- ------------ ---------- ---- - / �ON-A T ._, - --------------- r 3 , ' - FINAL I5RE Date.-- -------- -`l_ SAN JOAQUIN LOCAL HEALTH DISTRICT 1=Qzellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ,California E Lodi,California Manteca,California Tracy,California ES 9 REVISED'LB-S9 3M 3-'63 F.P.Ca. ' r,F _ 5 1