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ti <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) b <br /> Date Issued l-2 <br /> Applica-lion is hereby made to the San Joaquin Local Health District for a permit tonstr t a dinstll the work herein described. <br /> This application is made in compliance wit90unty 0 inake No. 549 <br /> t -i cod <br /> JOB ADDRESS Aa,,;LOCATI, N. -- ----- --- ----------- ---------------1c;-----------;�Clj----------- <br /> ------------------ <br /> Owners Name.....I Aft-------- - - - ---- - --------- - ----- Aw--------------------------- Phone----------------- <br /> Address----- AW ---------- <br /> - ---- - -------------- -----—,-------------------------------------------------------------------­----------------------- <br /> ..:..Contractor's Name_ -----------------m------------------- <br /> Instailation will serve; Residence E] Apartment House El Commercial 46-0051P7 -1 0 r Court 0 Motel F <br /> railer Other El <br /> Number of living units: -------- Number of bedrooms ------_ Number of baths Lot size 7-A <br /> ---- ---------mmimw--------------- <br /> e <br /> /Water Supply: Public system J�omr;unify system [I Private El Depth to Nater Tab llv�rtf. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam Ej 'Clay Loam Ej Clay ❑ Adobe kWH-TaTp"a_, [:1 <br /> Previous Application Made: Yes [] No lookew Construction! Yes AAWNr[ <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 from foundation--- ----- ------------------------------- <br /> No. of compartments.......1------------Size-15 Ae'j&_.Liquid depfh__%_5__'_..---------Capacify/_4!��qg_____ <br /> Disposal Field: Distance from nearest well-/-IAt.-.--Dlsfa:n-c'e.ir-om foundation-,/ .-/-----Distance-fo'nea rest lot lin,_�--- <br /> or ;6----A/ of each line_.___%S.V-------------Width of french....;4�----------------- -- <br /> Number 1 lines--------41 <br /> ----------- ----------- <br /> Type of filter n4ate I Depth of filter maferia 7" ------ <br /> L -.Total length <br /> See ge Pit: Distance to nearest well_,0__ �_ __Distanc f om foundation---- -"_Distance to nearest lot line----,S ------ <br /> Tour <br /> mate rial_Xz" Size: Diameter---- Depth....Z4'_4--------Deptn_...�2�3_____________________ <br /> Cesspool: <br /> Number of pitsk....../---- -------Lining <br /> I ....... ------------------- Lining material_-------------------:1--------- <br /> &sspool: Distance from nearest well_________ Distance from foundation. <br /> Size: Diameter-1---------------- -------------------Depth-------------------------------------------- --------Liquid Capacity---------------------------.gals. <br /> Distance from nearest well______________1_______________..____-_._._____Distance from nearest building.____...______._______________ <br /> ❑ <br /> uilding------------------------------El Distance to nearest lot line_____________________--------------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):----------------- ---- -------------------------------- --------------------------------- -------------------------------------- -------------------- <br /> --------------­------------------------------------------------------------- -------------------------------------- ---------------------------------------------------------------------- ---------------------- <br /> ----------------------------------------------------------------------11-1-----------------------------------I---------------------------I-------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have r' ared this application and that the work will be done in accordance with San Joaquin County <br /> ate laws, and rues Fd` <br /> ordinances-k regulations of the San Joaquin Local Health District. <br /> A - ----(Signed),_1--- ---- --- ---- ------ -- - --- - -------- • <br /> -------- ---------------------- -------------- contractor) <br /> ------------ <br /> ------ ------------------------------- (Title)- -- ------------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc.�, can be placed on reverse side). <br /> FOR DEPARTMENT,USE ONLY <br /> ale laws, and ru es a <br /> ... . ...... ------------------- <br /> APPLICATIONACCEPTED BY--------------------- ---- -------------- ----------------------------------------4 DATE---------- ------- ---------------------------------- <br /> REVIEWEDBY------------------------ ------ -------------------- DATE-------------------- ---------_-----_---- <br /> ----- -------- ------------- ------ --- <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------- DATE---------------------- -------- <br /> -----_-_--- ------- ------------- 4Z. 11 --------- ---- -_ -4-------------*-------- <br /> Alterations and/or recommendation's,-------------- ---- --------- ------------------------------------------------- ------------- -7 A-`•------------- <br /> --------------------------------------------- ------------- -------­­­......... <br /> ------------------------ -------------------------------------------- -------------7---- ------------------------------------------- <br /> ------------------- <br /> ------------------------------ - -------------------------------- ---------------------------------•----------------------- -- - ------------------------------------------------------------------ <br /> ---------------------I------------------------ ------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> ------------ ------------------ -------------- -------- ------ ------------------------------------------------------------------------- ­­------------------------------- - ------------I----------------------- - <br /> FINAL -INSPECTION BY: - ---------- ----------------------- Date__------------------------------------------------------------ ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Sfaekton, California Lodi, California Manteca, California Tracy. California <br /> ES—cj—zm 145446 !1TW00D 12-5a <br />