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rUKUttit-e uat: <br /> _ ka/LICATION FOR SANITATION PEk AT Permit No. <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued -. .. -3... - ` <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. / J i <br /> JOB ADDRESS AND LOCATION._ ^�-rvl_ L..__.1>1e?; ---/. ? f�/-=---- /� .).._....---..... . . ------ <br /> Owner's Name - /_— );P7/Z..... C-r--------- ----------------- .... ..... ....... .. -- - Phone-------- ---------__------------- <br /> Address.......... <br /> ...._+ --�- - -y-- - - - -- -... ........... ------------ ------------------------ -- <br /> Contractor's Name...... ----` C� ..........................- -------------- Phone.................................. <br /> Installation will serve: Residence ®"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: . _ Number of bedroc r,s Number of baths 1_. Lot size <br /> Water Supply: Public system ❑ Community system p Private A-'6epth to Water Table42� ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®/Hardpan ❑ s <br /> Previous Application Made: (If yes,date_... -. _ _.... ! No�eNew Construction: Yes Jq- Mo ❑ FHA/VA: Yes 41—No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_.7e: Distance from foundation..../?,"- . Maj fal�_4 t- Ly+J`�' - <br /> e __._.... . <br /> ®� No. of compartments. .... ...... ..Size: /f X-6tguid depth. - -_. __. _- Capacity-/Ze5el.- <br /> Disposal Field: Distance from nearest well.yy'1��i... .Distance from foundation...,e1.`:2._--_..Distance to nearest lot line-��-_.--- <br /> [Z}� Number of lines _._;2. _ . . Length of each line.. Width of french-A-....... <br /> Type of filter materia}�AC,C..Depth of filter material._.rf,?� _. Total length-.,Z&2-------------- ----------- <br /> Seepage Pit: Distance to nearest 99well__o-e-e.'-Distance fr m fougdation_./E�-. ... Distance to nearest lot line..`---..- <br /> 9}� Number of pits_.12...___--.Lining -laterial.�jite.C�. Size: Diameter-.>?-_;?'�. .... Depth 2,;1 '.....----__----- <br /> Cesspool: Distance from nearest well ._......... ...Distance from foundation . Lining material.......__.___._.......___---. t <br /> ❑ Size: Diameter. ___ -.. .. .__...Depth_...... ..._. _ ----------- __. _. _..Liquid Capacity_- ............____.gals, <br /> Privy: Distance from nearest well_.___ . .... __.. .. _.. ..Distance from nearest building. .... ......__--.--- <br /> ❑ Distance to nearest lot line .__ _. ---..----...--.- --------.. <br /> / �� <br /> Remodeling and/or repairing (describe): ---._.... Q.li(/.----.�E��.''-.-/_�_-.:��.y�£�./��.------............- ------ ..................... <br /> -------------------'----------------------------'--- --`-`........"-' ---___......_.-.......... ...._--------------- -- -------- <br /> -- <br /> ---------- -------------------------.---....-- ---------------­-- ------------­-------- -------------- <br /> I hereby certify that I 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 of the San Joaquin Local Health District. <br /> (Signed). . .. - - G" v- -✓Lr-.� ._a--�� .._. . ------ - ---_.. _ ...---- --. Contractor) <br /> By:................................ . .. -- `6 Z2 --- <br /> (Plot plan, showing size of lot, location 0f sys+ n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.... .._:....__..- - -- . ------------ - -------------_. DATE.. ' .............'- '_...... .... <br /> REVIEWEDBY----- ------------- - - ---- - ------- ------ ------ -- ......._......... -- - ..-.-._..... DATE--------- ------- <br /> BUILDING PERMIT ISSUED-------- -- ---_.....-. ..... ........................-------------------- .. .__.. ...._... DATE.- . - ----- .......... .... -- -- <br /> Alterations and/or recommendations:----- ------ _-- ....... ....---- ------------------------ <br /> ---- ------------ --- --- --- ..... - -`- - -- - <br /> -- ........- -- ------------ <br /> --- -- ------- ---- - - _... .. . --- -- - -- -......_----._._ .......... ....... ........ - .................... ------ <br /> --- --------------- ---- -- - .. _---------------. <br /> _..... -----.-. --- -.- <br /> FINAL INSPECTION BY ___.__.-_-.-:_:. n <br /> ----- ..... Date--------.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street <br /> 5leckton, California Lodi California Manteca,Co lifornia Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />