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FOR OFFICE USE: Permit No. <br /> --------- ------- ----------------- ..... ......... APPLICATION FOR SANITATION PERMIT <br /> ............ .... ....... (Complete in Duplicate) Date issued .... <br /> -- ---- This Permit Expires I Year From Date Issued <br /> o construct and install the work herein clescrlbe& <br /> Application is hereby made to the San Joaquin Local Health District for a permit t <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.." ..... <br /> Phone2�Axeel..... <br /> Owner's Name_ ----------------------------------------------------------------- <br /> KC,-'_eA1`n1.5W........................----------...................-------------------1-11-1----.-....- ---------------------- <br /> Address................... <br /> *e hone,�. .. <br /> ",e-...................... ......._ P <br /> Contractor's Name__.....lv-" ...... Trailer Court 0 Motel 0 Other 0 <br /> [3 Commercial <br /> 11"fallatilon will serve: Residence C] Apartment House <br /> Number of baths Lot size ............................ <br /> Number of living units: .'- Number of bedrooms ..— - - ' * I <br /> Water Supply; Public system 0 Community system 0 Private 0 Depth to-Water Table-�&. ft. <br /> Character of sail to a depth of 3 feet: Sand[I - Gravel C3 Sandy Loam D Clay Loam [I No 13 Clay 0 Adobe e Hardpan 0 <br /> previous Application Made: (if yes,date.._......._...-_.) No New Construction: Yes e No 0. FHA/VA:Yes El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool Permitted if public sewer is available within 200 feet-) <br /> . .......... <br /> Material— ...i------ <br /> Septic Tank: Distance from nearest well..14'le'.. Distance from foun --- - depth_..-'-- <br /> Capacity.... ..... <br /> *.,JV Liquid �j <br /> yj!S0 No. of compartments---- . ...............Capacity. a7 <br /> ni nearest lot line._..- <br /> Disposal Field: Distance from nearest well.IjW.......Distance from foundation....A.5"......Distance i le)A <br /> dth of "rich...........L ------------- <br /> Number of lines-----......j..................Length of each line--------0.0-- -----------Wi <br /> Type of filter material.-. -Pmaterial. Jlf'" langth­­ e-n-1............... <br /> .,4& <br /> -ic-----...Depth of filter <br /> ....._-Distance from foundatio ....!FT.....Distance to nearest lot line---!,S..... <br /> Seepag Pit- Distance to nearest well.... ................ <br /> ,a Number of pits--------/...........Lining materiai-20c'k-------Size: Diameter....... <br /> ff foe ......Distance from foundation.. ...... ..........Lining material.............-----------........... <br /> als. <br /> Cesspool: Distance from nearest well"."------ ........Liquid Capacity- --------­­.............g <br /> 0 Size: Diameter- ----- ----.-_-_--------Depth_-----------.......------------------ <br /> nearest well".-..._""._".--.."...------------............Distance from nearest building--------------------------------------- <br /> - <br /> Privy: Distance from . . -_...... ........ ... <br /> .__... ........ <br /> Distance to nearest lot line------".-..."..--- ................-.-.._1...11 ....------ <br /> ❑ <br /> Remodeling and/or repairing (describe):......W,52l� --V- ......................... <br /> ------------­--------------­-----------­---------------------*­-------------- ................................11......I.................. <br /> .....................­............................... ..................__------------1................................­................................I....... <br /> ------------...... ........ -------------........I......................................... <br /> .............I ••-.•.....-".."""_.............."".._..__ ............... ........-------------------- ........... <br /> I hereb,certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, tate laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Si•gned) <br /> .---"".._..-...(O wner and/or Contractor) <br /> ................ ................ <br /> ..............I....... ........(Title).....-le.. ---- <br /> By...........JeVW ......_6e` <br /> (Plot plan, showing size Of lot, lac ion of system in relation to wells, buildings, aia. can be placed on reverse 5id <br /> s` FOR DEPARTMENT USE ONLY <br /> ......................­­­­_................ DATE__18,m-l�­--­(V--__4 .......­........ <br /> APPLICATION ACCEPTED BY. .......... DATE--........._...._­­------------....................... <br /> REVIEWEDBY-------- -----------------___------------ .........................----------------------- DATE--------------------------­-----­..................... <br /> BU�LDING PERMIT ISSUED..."..................--------- ---------- <br /> ---­-----------............... --------------- <br /> Afterafians and/or recommendations:_._......------......-....... -- .............1.11 ................... <br /> -----------­- ------- <br /> -------.................".._-.."_.-.-........111..1...-----........ .................... <br /> ............ --------------------I....... <br /> ..................._---------- ............1-......................... <br /> - -51- --------------- <br /> i�...... ... - ....I.. ....... ­­ <br /> .............................. ................................­.......................................................... <br /> -----------------11.................I............ <br /> .......................................... ....... ...................... ... ... .... ......................................... ...... ......­­............................................................ <br /> Date....._...." —---------------- ......... <br /> FINAL INSPECTION BY:. .... ... ......... .51;1?Ole- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American ShearTracy,California <br /> 300 Wain Oak Striat 124$Yaofflwl S~ 205 West 9111 Proof <br /> siocklen,California Lodi,California Monism,California <br /> p,, I,Fa 9.59 2M 5-di ATLAS <br />