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FOR OFFICE USE: <br /> ----- -------------- --------------------------------- --- No. ---Fh4 <br /> APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date Issued <br /> --------- -- -------- -------------- <br /> ----- -------L------ -------------- <br /> ---------------- <br /> ... This Permit Expires I Year From Date Issued <br /> ------------ -- --- - <br /> Application is hereby madejo the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> .comp This application is made in. . �i with County Ordinance No. 549. 2-04, ?,0—oz— i <br /> .;J17 z s. 45 41'1-) 5 <br /> _-P&v ------s ------- -------- <br /> - - -6F <br /> 8 ADDRESS ANbLOCKRON------ --------- .9- ----- <br /> FN Mia , <br /> AIZZ M_AN 1>------------------------------------ ----- ---- ----------- Phone------------------------------------ <br /> Owner's Name--------- ...r <br /> -N.T-C 1L)---------------------------------------------- -------------------------------------- <br /> Address------------_-- --------- --------J-1'37------ <br /> ------------ Phone---------------------------------- <br /> Contractor's Name__PW_N_EP�------------------------------------------------------------------- <br /> it s I <br /> Installation will.serve: Residence P, Apartment House [] Commercial P,OTrailer Court [I Motel r Other EJ <br /> Number of living units: U-I--- Number of lbedrooms -3- Number of baths _ _ Lot size --- •------f------------ <br /> Water Supply: Public-system10-1 Community <br /> system isystem E] Private 9?-"DepfK to Wafer Table 0--- ft. <br /> V <br /> Character of soil to a'depth"of 3 feet: Sari-d[Gravel E] Sanclyioam E] Clay Loam [:1 Clay E] Adobe[] Hardpan [I <br /> Yes [e'-N o E] FH No <br /> Previous Application Made: (Iflyes,cicite ------ No [P-- N6W Construction: Y FHA/VA: Yes L'_T <br /> .'TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Nonseptic tank or cesspool permitted if 1public sewer is available within 200 feet.) <br /> F_T_ <br /> Septic Tank: Distance from nearest well--_G ---- Distance from founclafion-IjO--------M PTI ----------w--------------------------- <br /> j <br /> )P�city_./ <br /> Jnr No. of compartments--------- ----------Size-57--K Al A-5--- Liquid clep�h------- Z cit ----------------- <br /> .A nearest lot line <br /> Disposal Field: Distance from nearest well L,� __Distance from foundation___/0_____ Distance to neo Zq --------- <br /> L <br /> -"---- - --------------------- <br /> e Number of lines-------- ---------Length of each line--------? ------- Width of trench.-_ <br /> - <br /> Type of filter material-A a)-"--,---Depfh of filter material-------1'7---------Total length__ IO--------------------- <br /> S <br /> II e to nearest lot line-___..___________ <br /> ' Seepage Pit: Distance to pits------------------)-!- <br /> earest well-_# ------ ---------Distance from foundation____-____________-_Distance I <br /> Diameter +'n--!--------------------------- <br /> Number of: pits------------------1_!_Lining material------------------- -Size: --------- - ---------Dep <br /> El Cesspool: Distance f!%"-qearesf..we.!J----------------Distance from founda�fiion--------------------Lining material__._.._-_-_-________.____.__.___-___.. <br /> Liquid Capacity---------------------------gals. <br /> Size: Diam6fer--—------------------------- ------Depth------------ --------- --------------------------- <br /> L.4 <br /> Privy: Distance from nearest-well--- --- ------------------:------------- -------Distance from- nearestbuiic1ing._t._.,____1------------------------------- <br /> Distance to nearest lot line------------------ -------Z---------------------------------------------------❑ -------------------- <br /> --------------------------------------------- = <br /> and/or repa'fring,,(d6scribe):----------------------------------------------- -------------------------------------------------------------------------#--------------------------- <br /> y <br /> ---------------I---------- ------------------------------ <br /> "I t ------------------ ------------------------------------ -- <br /> ------------------------------------- ---------------------------- <br /> ----------------- ------------------------------------------------ I 1 .1 <br /> f's A ------------------- --------- ------ <br /> ---------------------------:--,r------------------------------- ----------------*-------------- ----------------------------- <br /> ----------------------------- I <br /> • --------------------------------- ------------------ ------------------------------------------------------------ ------- ------ <br /> ------------------------------ -- ------------------------------I------------- ------------ <br /> I hereby,certify that J.have prepared this application and,that the work will be done in accordance with San,Joaquin County' <br /> ordinances,'State laws, and rules and regulations o; the San Joaquiri Local Health District. <br /> 4 <br /> --------------------- ------(Owner and/or Contractor)N <br /> (Signe )---- --- ----------------------------- <br /> ------------ -- ----------- <br /> -------- --------- --------------------------------(Title)------------------- ......................... -- ---- --------------------------------------------------------------------- <br /> -on re�__ e <br /> (Plot_P_Ii6,,—S"OiFg size-of lof,-166 ation of s�yste—m­in­rel4i6in�f 6-w—elli, 66ildi—ngs, efc�., can e Placed reverse sia')- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED 'Y..___7r_R_!_0------------------------------------ --------------------------------- DATE-------- ------------- r*4 <br /> ;REVIEWED BY--------------------------------------------- --------- -------------------- ------------------------------- DATE-------- ------------I--------------------------------------- <br /> BUILDINGPERMIT ISSUED---- -------------------- ------------------------------------------ -------------------------------- DATE--------------------- ------- ----------------------------- <br /> - <br /> Alterations and/or recommendations:----------a------- --------------------- i <br /> - <br /> ----- ----- ------------------------- ----------------------------------­­j--------------------------------- -------- <br /> -------------------------------------------I--------------------I---------I------ <br /> -------------------- ----------------I---------------------------------------------- --------------------------------------------- <br /> ---------------------- ---------- <br /> -- <br /> ---------------- ----------------------- --------------------- -------------------------------------I-------------------------------------------------- ----------__--------------- <br /> ------------ ----------------- -------------------------------5---------------------- <br /> - -- <br /> - <br /> ------------------- -------------­---------- <br /> ----------- ------------ -----------------, •_-:---------------I - <br /> -- -- - <br /> -------------------------------------------------- --------------------- ------------------ ---------------- ----- <br /> --- ----- ------------------------------------------------------------------ ---------------- <br /> 22 <br /> ----------- ---.-- - ----------- ------- ---------- ----- --------------------- <br /> FINAL INSPECTION BY:-,---- <br /> Date -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stacklon,California Lodi,California Manteca,.California Tracy,California <br />