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FOR OFFICE USE: - ------- APPLICATION FOR SANITATION PERMIT Permit No. . --------------- - ------- -------- ---------- (Complefe-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 construct and install the work herein described, This application is made in compliance v�with `County Ordinance No. 549. JOB ADDRESS AND LOCATION f Owner's Name f+- uv.• �-a s` "'4 ------ ------ ---- G4 6's�--^-: hoff�. d r`� Address----------- + %:_t .- —.---- -- -------------•---------•------------------- ------------------------------------------ Contractor's -------•--- -----__-_______-___ Contractor's Namur —40, l t�`--I-------- --- --- ------------ Phone------ .----•---•--------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ -_--- Number of bedrooms x;-1- Number of baths ._oZ- Lot size _ oi�47-__----�,0'a----------------------- Water Supply: Public system E] Community system ❑ Private & ftsDepth to Water Table AU Character of soil to a depth of 3 feef• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,date_.-_-__._----__--- ) No Fq""New Construction: Yes [4 f—o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-179O.- Distance f7om foyndati n__el --_-__--.Mat ri I - ._/'�� 3- -__ `Aj 6 p �� ' No. of comparfiments-__p __-._____-_.-.Sizes ? _Liquid depth_,� ______ _______ Capacity__ Q -.--- r Disposal Field: Distance from nearest weil—;W.-Distance from foundation_.1-�-4__--.-._.Distance to nearest lot Number of lines ----- ___ en th of each line_- __ =-- -- - ----- 9 - �1-��----p,----Width of trench.- •2-�; - -------------------- Type of filter material-,,". .�- -.-.D--- epth of filter materia l___f _____-_dotal length---��i�__ ________________________ Seepage Pit: Distance to nearest well.N3149/-__-_.-Distance frgzn foun ation_%O--Q_-_._-_ Distance----Depfih_to nearest lot linp__ta' ~____-__ p -/----.--Lining material__ - _Q ___ Size: Diameter- �� Number of its---- ----- ------ �3----- �_+�---------------------- Cesspool: Distance from nearest well ___________ __Distance from foundation----------------- ..Lining material-..... ------------------------------ El Size: Diameter. ._ ---------_____ -- -------Depth-------- - --- -------------------------- ------Liquid Capacity--- ------------- ---------gals. Privy- Distance from nearest well..----_----- _------------------------------____Distance from nearest building--------_____________-_---__--_-____--__-- ❑ Distance to nearest lot line - Remodeling and/or repairing (describe):------_-_. /_ _/_...�- /-- r - `f'l--_ f �- -�71 - --------•----------------------------------- ------ ---- --- - �"/ 'l/1 ----------- -lr�G lr !l ��_ '� -- --" Cir /__ --------------------------------------------------------------------------------------------- -- ! hereby c rfify that I ave prepare this application and that the work will be done in accordance with San Jofquin County ordinances, State laws, and rules andregulationsof the San Joaquin Local Health District. (Signed)-•---------------------------- f�' Y - ner r Contractor) BY: ------------------------- 11", ---------------Title -_ ( ] / �- (Plot plan, showing size of lot, location of system in ;friiono wells, buildings, efc., can be placed on reverse side]. l R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------3 AX7-------------------------------- DATE----1,1'--/,�-`4.-T---------------------- ------ REVIEWEDBY--------------------------- ----------------- --------------------- --------------------------------------------------------.. DATE BUILDING PERMIT ISSUED-------- - -------------------------- ------ --------------—-------- ----------------------------. DATE Alterations and/or recommendations:_.__ _ 1f _ - ----1 - rI` yf ��. � �" �`' �-----'� �---cJ--�L`f- -t----- �-:rte. -:-----i�. - - -/ ��___--��r---- - fi'!:-+�-•�- --------�---- -- G-- -- -- O/C PPI e-0 0'rf+1 / CCL (' 1 FINAL INSPECTION BY:.--- ---------r-------- Date------ - ------------------------------------------- A OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 245 West 9th Street Slockfon,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press