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FOR OFFICE U$ : a R y ---------- -------------------------- ---------- ------- APPLICATION FOR SANITATION PERMIT Permit No. .-C7.��1�.3 ------------------- ---------- ------------------------- (Complete-in Duplicate) -------------- ------ ----------------------- -------- I This Permit Expires 1 Year From Date Issued 7 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct an2_5 inks}all the wok herein described. This appGcation,.is=made..in,compliInc, with County Ordinance No. 549. �72,3 E., ,�-[�.c..Td..1 ,per•. _ J08 ADDRESS'AND LOCATION_. --!Q_''''"'+►y --J -SG� ---- = ----------- - -------------- -------- Phone------------ Owner's Name----------- -------------••---- Address---------------- r l_ *� T-ec ------ ---- -------- .' ----------------- ----------------- Contractor's Name------------- - i- - F - ------ ----- ---- --- - ---- ------ - --------------- Phone Installation will serve: Residence _jApar-tment_H9ussef11 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ (a, Number of livingunits: __ -.-.- umber f bedrooms _ • w Number of baths-.��,-- Lot size ----- Water Supply: Public system ❑ Communisystem E] Private Depth to Water Table ft Character of soil to a depth of 3 feet- SandGravel E] Sandy Loam [ Clay Loam E] Cay El Adobe F1 Hardpan E]Preriaus Application Made: (lf yes date_..---____...._ _ J No E___ New Construction: Yes [0""No ❑ FHA/VA: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f _ jNo septic tank or cesspool per if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well Yo Disfance from foundat•Lon--1Q.. Material .1�/7 7"0'119 = ` ,�».., ! �I[� --- - --------- -- ------ No. of cam artments..r+ �� f� -_ `�_t.k.,��a5ize�Qsr.Y��ifG`'��'L�'quid�epth__.-,1[d�.�_.. .-----Capacity--��4-��-q � Disposal'Field:field: pistance from nearest well--. _�-C)--_-_Distance from foundation--v)--D_--.---_-Di tance to nearest log line--------------- ' 0� Number of Ines. ------------Length of each line-- -- S--- Width of trench.- �--------------Type of filter material_.-1 _.. p. epfih of filter material-_�-�__.-.-----.-_To{'al length-__j--- -------------- -------------� Seep 4ge Pit: pistance to net a�est well_- -.----- Distance from foundation----- i --------Distance to nearest lot line---------- ---..- I ❑ Number of pits Lining material Size: Diameter---------- Depth_ Cess ool: Distance from nearest weft __-------------Distance fro r>5 foii�dation.........._...... ..Lining material-------------------- s ❑ Size: Diameter- ------------ --- ------------Death----------- - "---------- -----------------liquid Capacity-------------- --------- r, Priv Distance from nearest well I ._---------------__----.-_----_-.-.- ,�Jdistance from nearest building ------------------ ---- ❑ Distance to nearest lot line ----------------__- ro Remodeling and/or repairing fdescribe)---------------------------------------------- . - --------------------------------- --------------------- -------------------------------------- -------------------------- ------------ ------------------------------------ ------------- ---- -------- ---------------------------------------*4' ------------------------------------------------------------------- ------ f -- = - -- �== ------- _..,.,----------------------------------------------------------- I hereby certify that I have prepared this application and that thework will be done in accordance with San Joaquin County . ordinances, State laws'. and rules and regulations of the San Joaquin I:ocal Health District. (Signd) { / Contractor) ---------- ------ � - O d -.----- -- y -- --- ---------- � � --. caner and/or By----------- ---------I-------------------------- - --------------- i ` --------- -------jTitle)_ - .... -- i (Plof plan, showing size of lot location of system in relation to wells, buildings, etc., can be pll(ed on reverse side). kr I - - FOR=DEPARTMENT,USE ONLY r a, APPLICATION ACCEPTED BY f � � '.- -------------- ---- DATE: 2� -----� 6- -------------------- REVIEWED BY ----------------- _n� .a� ::_:::_DATE PERMIT ISSUED-------- -- ------------------------- - -- ------ DAVE-------- Alterations and/or recommendations:---_.............. --- ---------- ------ - - -----------------------------•-------------------------- ------ ---------- -------------- ---------- ----- '^ —_,i ---- ------ --------------- -------------- ------------- i FINAL INSPECTIO Y:-_ _. --_- Date-- -------------- -.-.�- � ------�- ----------------..-- �- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street slacklon,California Lodi. California Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press