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FOR OFFICE USE. -------------------------- -------- --- --------- ----- -, 7 APPLICATION FOR SANITATION PERMIT Permit No. ........................ I------_ r • _issued Date`Issued _ z --- ---------------------- --------------•- .--------- -- e (Complete In up icate) _ This Permit Expires 1 Year From Dat Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herelncrbed. r This application is made in compliance with Coun. O dinapti 'No 549. �C}LQ�1 RTF- - �' � x 67 Esc, = ' � JOB ADDRESS AND LOCATION--------------- - - Sl.J? --- _:._. -- -•----0-P--:_- Owner's Name - 1-11 F- `.L .. Q_ _�.1 "- � Phone ------------ Address--------20 - �` A C_Z-51- ---0-- ---------------------------- ---- -----•-•------•-..--.------------- ----------- f Contractor's Name-07001 IILo 13� <- -------------------------- -------- ---- 1 . Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number,of,bed rooms,.•_Z_Number' of baths _1_____ Lot sze ._14 14 =_____.______________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table:------ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E] Clay Loam ❑ jClay E] Adobe El Hardpan [I�,,t�� 5 Previous Application Made: (If yes,date..___.±------------I No��Nery Construction: Yes IES iso ❑, FHA/VA: Yes 21----No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) l , Septic Ta Distance from nearest we{I__.5r__Dis#ante from foundation---�______________M to ial___ Dl�� _�-�__ ___. No. of tom artme�rifs____ _SizexS_.'_______________Li uid de tht_ __--..Capacity-AVT __.____.r__ P q P. - - Z 0D Disposal F• ld: Distance fromknearest well.-.5Q_._,_Distance from foundation __Q__��'tthce to nearest��ki;e__ _r__________ �•_-- Length of each line_=__ „ I .� C--------- IF Type of filter.mater #_.Total length___.---.--.__,- Q________________ Number of lines_____. :al__��-C�__Depth of filter material____._/_�____ # Seepage Pit: Distance to nearest well--_.______�A___-__Distance from foundation_______________._.Distance to nearest lot line----------------- � X-1 , ❑ Number of pits------ --------------Lining imaterial--------------------.Size: Diameter-)_...•f---------------Depth-----.--------------------------- Q ❑ Size: Diameter______.�.______..-1---- ----/Distance from foundation___._____.____-FLining materia!______.._._______________________- 1 P } - ��Liqui Capacity --- Cesspool: � Distance from nearest we f---_----r� Depth }�'_______________________________ d Ca acit __-gals, Privy: Distance from.nearest well------- --------.-{--- __:r_..-}___.--- g-----------------=--------•_ / - _Dcstance-.from nearest building _-.:-.-.___._. ❑ Distance to nearest lot line____________________ ------------------------ -------------------------------- --------------------------------- ---------------------- / Remodeling and/or repairing (describe):°'.._ .___.__..a:!_.------ t ; f --•----•--------- l --------------------------------------------------------!t ------- --------------------------------------------------=------------------------------------------- n I hereby certify that liave:,pepar`ed this application`and that the work will be done in accordance with San Joaquin County ordinances, State laws and rules 4�nations of the $a Joaquin Local Health District. x , _ ..�_. (Signed) ----------------------------------- ----------------------`-----------------------,-(Owner and/or Contractor) _ . _ r _ - B - .._... = Y�-------------•-----------------=--.._-•----•----=-------- • = --_.-- = ------ ------=-----------------=----------=------::_ It a ----_�'- ---- .--�•---�-, , (Plot plan, showing size of lot,.location of system in relation to wells, buildings, etc., can be placed on-reverse side):' FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY---------- L� ---------------------- ---------------------------- ---------- DATE----- tl- ---------------------- REVIEWEDBY------------------------------------------------------- ------------------------------------- ---------- ---------------- DATE----------- ----------------------------------- BUILDING PERMIT-ISSUED = =------ ------------ ------=- - ------------=--- DA _ ---------=I----- ' --- - Alterationsand/or recommendations:-•-- --------- -------------•-------------- --------------------------------------------------•----------•-------•----------------------------•--•-------- ki el 0_-1-14,N ---till#�q-------------- - --------------------------------------- ----- t-------------------- ------------------------------------------- -- ------ ---- ----- --------------3---------- --------------+ ----- ---/............. - - FINAL INSPECTION--B. : -- -�J- -- --- - --- Date------..5— �.-6 ------- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 R.Hasalfon Avs. ' 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockloo,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.54 3M :5 •63 P.p.CO.