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FOR OFF-I.(,-:E USE: ------------y_ ______ __________ ------------ ---------------------------- ------------------ ------ - APPLICATION FOR SANITATION PERMIT Permit No. (Comple+e,in Duplicate) --------------------- -------- -------I This Permit Expires f'-Year From Date Issued Date Issued 6nR�7 Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application-is-madeincompliance with County Ordinance No. S.49. A-c/e- _11bB ADDRESS Aki LYCATION_ Y" ---------- ------------- ------ Owner's Name---- -- - ------------ -------------- - Phone------------------------------------ --------------------------------- Address......4>Q-%.t------ ...44-v--- ------------- ---------------- ------------- ---------------- ----------------------------------- 47 .. ...... Pirone-Z r--1-74,6 Contractor's Name------ - -- --- - - A ---------00� Installation will serve: Residence X Apartment House El Commercial E] Trailer Court f9_�_M_qtel ❑ Other E] Number of living units: -- ----- Number of bedrooms Number of baths -------- Lot size- ----- --- --1 -- --------- Wafer Supply: Public system El Community system El Private'PC De PW fo'Waf;r Table aV,it I ' 1 .Characterof soil to depth of 3 feet- Sand X., Gravel El SandyLoamE1 Clay Loam o Clqytj, AdcbeE] Hardpan (-] Previous Application Made: (If yes,date_.._.............. ),No New Con'struci;on: Yes E] No'�U� -FHA/VA: Yes E] , No 7 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 100 feet.) Se-tic-Tank- pDistance from nearest well_________________Distance from found 9flon-n:---------------Material ........... ------------------------ ❑ No. of compartments--------------------- Size _ Liquid-,"uid clepjh----- ... ....... ........Capacity.-.----- Distance from nearest well . Disposal Field: --------------------------�t _1,0.&. .....Distance from foundatioii__"q&0L--- Distance to nearest lot 'ne-- ------- Number of lines------- _-Length of each line-- ------Width of french_-A-,,21!��---------------- e filter-mate ria I _-__-_.__.Total length---- _A4------------------------ Typ '.'of filter material-----I- --------_-Depth Seepage Pit: Distance to nearest well___________________-Disfance from founcl`ation_~-----------------Distance to nearest lot line.-.--_--.________ �. ,❑ Number ne.,_------------ Number of pits--- --------- -------Lining m "al ........ ------------ Size: Diameter------------------ - --Depth--------------------------------- Cesspool: Distance from nearest weld ________________Distance from foundation..__...._._.... Lining material-..._________________--_._._______- 4 171 Size: Diameter_ -- ----------- - .. - ---- ........Depth----,---, ------------------- =---------Liquid Capacity-.--------------------------gals. Privy: Distance f'rom nearest welL_-,- -------- -- ----------------------._..Distance from nearest b0cling------------------------------------------Lz, ❑ Distance to nearest ]of line............ -------------- ---- ------------------------------------------- --------------- Remodeling 6nd/or repairing (describe):-----".�. ------U��_a ---------------------------------------------------------- --------------------- ------------------------------J7 ---------------- ----- ------- --------------------------- ------- ----------------------------------- --------------------W------- ------------------------------------------ ---------------------------------k ------------------------------------------ ------- ------------------- - -- ----- -------------!--------------------------------- ------------------------------------------------------------------------------------1.k------------------------------- ----------------------------------------- - I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- ------------------------- ------ ----- -------(Ow"M-e*eVor Contractor) -- --- ---- -------------------- ................ ----By:------ -1) ------ -------- ---- --- --------------------------- (Title)-- (Plot plan,-showing-size of o system in relation to wells, ildings, etc.,;can be placed on reverse side). J FOR DEPARTMT USE ONLY P — , 1. APPLICATION ACCEPTED BY-- ---- -- 0---------- ------ ---------------------------------------- DATE- ---- ---6 ------------------- - ---------------- -- REVIEWEDBY-------------------------------- ---------- --------------------------------- ------- - --------- ------------- ----- DATE------------- --------------------------------------------- - BUILDINGPERMIT ISSUED--- -- -------------------------------- - ---------------------------•---------- -- .............. DATE Alterations and/or recommendations:------------------------- ...... ------------------------------------------ ---------------------------- ---------------------------_---------- --- ------------------ - ------------------ ------------------i-------- -- ------------- 7 ----------------------------- ------------------- ----------------------------------------- ---------------------44_------D----------4-------------�_I)Yfww f7----------------------- ......... ... ------ .... ..... --------------------------- ------ ---- --------------- ---- ------------- --------------- ----------............ . ..... ------------------------------------ -- --------------------- --------__--------------- ----------------- FINAL INS CN BY- . .... Date --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street\ 124 Sycamore Street 205 West 9th Street Stockfori, California Lodi, California %6 Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press