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FOR OFFICE USE: Ao - APPLICATION FOR SANITATION PERMIT Permit No. . .....- - ------------------- - [Complete in Duplicate) l 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 with Countyy Ordinance No. 549. JOB ADDRESS AND LOCATION G7 ----•--------------------------------------- Owner's Name--------- V-17--- ew,*:-d4.7------------------ --------- --------------------- --------------- Phone------------------------------------ Address CT- ------------=---- -- -- ----------------------- ----------------- ---t-•- -------------------- ----------------------- Contractor's Name----------------- !' " � Tr - - ------ --------------------------•----------------•--- Phone----• .------••--•--------•------- Installation will serve: Residence❑ Apartment House ❑ Commercial ❑ ITrailer Court Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms Number of baths._.1--- Lot size,0-_`_0_-09-a---- �-------- Water Supply: Public system ❑ Community sysfem [] Private gq- 5epth to Water Table - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If'yes,date__..-------...::..: ) No 9?- New Construction: Yes —Jo ❑ FMA/VA: Yes ❑ No R TYPE OF INSTALLATION AND.SPEC FIFICATIONS:� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we1l_-e-: wf_47 Qistance from foundat' n---� ------ No. of com artments', - Size_��__-,ZW i uid de th. _ -.� Disposal Field: Distance from nearest weft/�`- �_Distance from foundation---�C _��Distance to nearest lot line-_1_,:r Number of lines /%/)!�_, da-Length of each line_ , _ ./r ._Wed+h of trench_ �-- Type of filter material-�/eef�Depth of filter material_��F.----..Total length-��_�--------------------------- y Seepage Pit: Distance to nearest well.!....:.::.:.....:::..Dist ante from foundation------------------- Distance to nearest lot line--.____---------- ❑ Number of pits--- ------------ .-.-.L-.fining material---------------------- Size: Diameter--.--------------- ----Depfh--------------------------------- Cesspool: Distance from nearest well _--------------Distance from foundation------------------- -.Lining material---------.......____._------------_-- ❑ Size: Diameter- -- --------- -f--- ---------------.Depth----------------------------- - - ----------------Liquid Capacity----------------------------gals, g tl f Privy: Distance from nearest,well-____------------------------------------------Distarce from nearest'building..___-----------------__----_.-.---------- ❑ Distance to nearest lo. le - f ------ 16)(s y a Remodelin and/or repairing describe : 3_+1 .s' 9 / p 9 ly l } ! _ J7..�.�.�� .. � ��7---------- ----------------------------------------------- -------------------------------------- - i ._..---''-`------------------------------------ ------------------------------------------------- ---------- �_-----•-•--------------_----------------_----_---_--__-_-_----ew---- ---. - t -- ------------ --- - ----------------- 4 --------------- = " I hereby certify that I have:prepared this application and'that the work will be done in atcordance with San Joaquin County j ordinances, State laws, and rules and regulations of-the'San Joaquin Local Health District. - e [Signed]--- ------ •- -- -- --� -�--------- •'-- ---- ----------------------- - - ---- - --- ---(eWM==Vor Contractor] By:------------------------------------------ ---------- ----•---- --------------------- ---- ------- ----------------- . [Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., tan be-placed on reverse side]. -4 FOR DEPARTMENT USE ONLY 4 ' APPLICATION ACCEPTED f3Y---- ---�/��e -- - ------------- ---- ---------------------------- ----- DATE...... ----��---�---- --------------- ""n REVIEWED BY------ ------------------- --------------- •------- -- ---------------------- ----------------- DATE ----------------- BUILDING PERMIT ISSUED-------- -- ------ DATE---------------------------- Alterations and/or recommendations:------- -- ---- -- ------------------------ ------------------- -•----- ' ----------------------- ------------------------------------ ------------------------ ---- ----------------------------------------- --------------•------------------------------ - 0 ------------------------ --------_--- _--.-------------ti __-___-----.-------------------- s ----------------------- FINAL INSPECTION BY:..---G4/ ------- ----- ---------------- Date-------- .+ {7 - SAN JOAQUIN LOCAL HEALTH DISTRICT 160 1E.-Hazelton Ave. + i 300 West Oak Street .= 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi, California i Manteca;California Tracy,California E.H.9 2M 1.67 Vanguard Press r