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FOR OFFICE USE: i <br /> ---'--"--'- ----- --------- --- ----------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ... . /_(�- �' <br /> (Complete-in Duplicate) <br /> i This PermitExpires 1 Year From Date Issued Date Issued <br /> Application is hereby made to`the San Joaquin Lacal Healfh Disfrict fora permit to construct and install the work herein described. ` <br /> This application,i-s-made in_,complionce wif h.County-Ordina nce—Ua..549. '- <br /> JOB ADDRESS fCATMZ:�_t `----- <br /> Owner's Name-- ------------------------- U--- .--A--------------------------- Phone- <br />_ � <br /> Address- ------ ---- --•-- -------t� ---•--•-•----------•-------------------------- <br /> �} � i <br /> I --A �6Z___14---L4C-----------A---- ' <� fU � Phone-4b6-9/1,07 <br /> Contractor's Name_._. _ <br /> Installation will serve: Residence K Apartment House ❑ i Comercial ❑ Trailer Court ❑ Motel ❑ Other [❑ <br /> Number of living units:?_____-_ Number of bedrooms!__ _ Number of baths_J._._ Lot size __��CL_j----6r_ -------- - -------- <br /> E � <br /> Water Supply: Public`systerri,-El "Community syste`m•❑ Private Depth to Water"Table7.6 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Grav l ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeA Hardpan ❑ f ` <br /> Previous Application Made: (Ifeye,date_-.._...--- J No New Construction: Yes ❑ No)g__.FHA/VA: Yes ❑ No <br /> TYPE;OF INSTALLATION AND`SPECIFICATIONS: ; <br /> No se +icl+ank,,or cess oolermfi d itif public sewer is availle within 204 feet.) <br /> Septic Tank`t ' ' Distance from nearest well_�----------Distance from foundation--------------------Material ----------------.------------------:----------- <br /> . <br /> ❑6xI5 tA7 No.. of compartments---------------------�-ISize- Liquid depth " ' .Capacity ' -'- ---'-'-' <br /> Disposal Field: Distance from nearest well..7- ...__Distance from foundation___2LC1...___..Distance to nearest lot line---X5------ <br /> Nu mber <br /> __.__Number of lines _ _. _ .Cii ........Length of each line__.__ Q.�__. Width of trench_...�s "_..# <br /> -_-._De_-Depth of filter material---_.__/--�t-_-_--.Total len th__gf1.'._-_-_------------------- <br /> Type of filter material._ _ _.... p g <br /> �., 1 r / <br /> Ma-_----- Distance to nearest lot IinefZ S�__.. <br /> Seepage Pit: Distance to nearest wefl_�_���...:_Distance rom f undation_ _. <br /> Number of pits�Ci-N.-.Lining material__ ._ <br /> Size: Diameter 3. ..........--- Depth--- --------------- w w <br /> Cesspool: Distance from nearest well ___---------__!-Distance :frorr 'foundation____...._........ ..Lining <br /> I material_ _..._____..__..-.--.-..-.-------,-. <br /> Size: Diameter- -- ' ------------ - ----- Depth --------------------------------F1 ..-Li uid Capacity. . a gals. <br /> Privy: Distance from nearest well..................... ---------.-------Distance from nearest building ..._. <br /> ❑r ,,...,Distance to..nearest_lot line -- ----------------- -_------------------------ = ----------------- ----- ---------------------------- ' <br /> Remodeling and/or repairing (descri�:-, -__ __t_- _l __.----_.___ __ ) <br /> ------ <br /> -----------------------------------------------------_------_.._-.-._____----...-------_---_-.------_-__--....--_-------_---_____--_._.--_-__._--______..._-.-_-__-- _ <br /> rE �... - <br /> >f <br /> I�hereby certify a e ptie ared this application and that Ile work will be done in accordance with San Joaquin County <br /> ordinances, State la s, and ru sand regulat' ns of the San Joaq ' Local Health District. <br /> Contractor) <br /> (Signed)----- -- --'--'--- -----'----------- --'-'-' -•--------- . .-'------- --;----A- - --- -----'-'-'- ---•-' --'------'-'--'--------'- - --[Owner and/or ontr tor] <br /> BY:--- ----- ---- �'---- -- =' ' ----------------------= '--(Title)---'--' ' `-'--- ........------------- <br /> [Piot plan, showing size of lot, location of stem in relation +o wells, buildings, etc., can be plat on reverse side). <br /> X ., ; it <br /> FOR DEPARTMENT USE ONLY <br /> h ,� .�- ' <br /> APPLICATION ACCEPTED BY- - - - '�--------- ---- -' DATE <br /> REVIEWED BY---- -------------------- ------------------ ----------------------------------- <br /> -------------------------------- --------------- - ------------------------ DATE--'-' '------'-' ------------------------------------ <br /> IBUILD IING PERMIT ISSUED-------- -- y -------------------------------------- ------------- DATE.-.----- -------------------------------- ---- -------- -- <br /> Alterations and/or recommendations:--- --------'---- -------- ---kj-----'-'-- ..." --------- ---------------------------------------------------'----=------------------- --------------- <br /> - <br /> -"' <br /> ------------------------------ ----- ; --------------- ­­ <br /> ---..._---/--------------------------------------------------------'--------------------_----------- ----------------------------'-------------------------------•----------_...__._..-------....._----------7------------ <br /> ------------ <br /> ----------------------------------------._..-----__._...........---�-----`-�-------------------------------_-.-...-..-------......------- <br /> --.-------- ------------.---------- <br /> \ ` <br /> F1NAL INSPECTION BY---_---- �.'-'-_--__-- '--- -"--- Date----'-......3- ._ '- / <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haaellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Slockion,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />