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rUK Urril-e UZ t: <br /> APPLICATION FOR SANITATION PERMIT Permit No. -12.l.—h.-�j <br /> { 0 �- �- - (Complete in Duplicate) s� <br /> Date Issued <br /> This Permit Expires 1 Year From Date Issued <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.! x / <br /> JOB ADDRESS AND LOCATIONGi O ,,Y3� -iy , NL�1 [Z �= �t/1C /1/.--Jam.•-_L FS( eCJn---A.Ytc_ <br /> Owner's Name.C. l }p j �1��Ji} � �^Z/PrQ G/� Phone.d.(r - -,/.3..�.-i_ <br /> , A1r- 4 ---6 44,t _... ............. <br /> Address-----...... l .� C1 <br /> Contractor's Name. A sP?42--1.544 .. A .J C`1'-C� -- . ... Phone-414- --f4-f--/------- <br /> Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -' :-- Number of bedroomsNumber of baths -- :: Lot size - 6_eG z-.sl-------------------........... <br /> ..-- <br /> Water.Supply: Public system ❑ Community system ❑. Private RL Depth to Water Table &57ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam,❑ Clay Loam ❑ Clay Adobe ElHardpan ❑\ <br /> Previous Application Made: (if yes,date___..............1 Not New Construction: Yes ❑ No - FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank orcesspoolpermittedif.publicsew'er is available within 200.feet.) .., <br /> Septic Tank: Distance from nearest well.................Distance from foundation_ ...-.-_._._.Material---------- ---- ------------------- _........ <br /> .. <br /> ❑ f 5 No. of compartments...-------_..------------Size........................._ ----Liquid depth _- .. ... ...---------Capacity....................... <br /> Disposal Field: Distance from nearest weII,00._...Distance from foundation fL'...... <br /> _..Distanr t to nearest lot line 5` <br /> t4 Number of lines �".._. //- . -._Length of each line--1?0. �•rr.-- ,..Width of french._.Z <br /> Type of filter material.-- C+tC.._...Depth of filter material-_-f--t?.-.__.._-Total length--.-..-�.:( :......................... <br /> Seepage Pit: Distance to nearest well-.4(--C,.�!�'_tgistance rom oundation_/1----r--.--..Distance to nearest lot line._!; <br /> �-- <br /> --_ <br /> Number of pits..-p�--)---Lining mbteriaL ,..--.Size: Diameter.-d$`.�..---..-Depth...-;Z, <br /> Cesspool: Distance from nearest well........-.......6ist8nce from foundation---_-_.-.-.------.Lining material.-_-_-------------__---.--- <br /> ...... <br /> .❑.. Size: Diameter-------------------------------=-----Depth-------- ---------------- .....................Liquid Capacity............................gales <br /> Privy: Distance from nearest well------.-------------------------------- Distance from nearest building--.-------.-.-----.-.--_.-.----..----__. <br /> ❑ Distance to nearest lot line-----------_.---'---------------__._............................................ ................................................ <br /> ... <br /> Remodeling and/or repairing (describe): `- . i _- ... • --------------__.... ..........-._.. <br /> -----... -..--.. . <br /> - - - -.. . ---- ._ --- -- -- - . .. --------------- <br /> - -- - _------------------------------------ ------------------ - - <br /> 4 <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co <br /> ordinances, State-lawsand.rules and regulations of the San Joaquin Local Health District. <br /> Si ned , C <br /> ( 9 ) -- -- ...-:--� / vim- -_-.-.--- .._ (Owner and/or Contractor) <br /> By:..... ='-- ---- G fL....C�-.- .. C 1 i 1<{! -_(Title) <br /> (Plot plan, showing i <br /> ca <br /> lze of lot, lotion of system in relation to wells, buildings, etc., can be placed reverse side). <br /> FOR DEPARTMENT USE ONLY g / <br /> APPLICATION ACCEPTED BY.--- .......-------- - -- - ------------- ----- <br /> ------------ <br /> -------------------- -- <br /> -....- DATE. ---3- /--.( `7--------- -------------- <br /> REVIEWEDBY ..-- ----- ----------------------------------------------...._ DATE-................ .............................-- <br /> BUILDING PERMIT ISSUED_........... ......----.....-...-....-....--------------- -.......... --- - DATE.---------------------- <br /> ----------------------- <br /> Alterations and/or recommendations:------- -------- ........................................................ .................................................. <br /> ---------------------------------- ----------­------­-----------­. ------------ .......... -------------------------------------............................................................... <br /> ecommendations:...............-------__........-..---_--.........---------...............-------...-----'---'--'-------------------------...---------'--- <br /> ...-----------_-...-----..... <br /> - <br /> --------- ----------------- -------------------.------- <br /> __. ...............__..___. - ----___------"-------..---------- /[ _-.--.--_.---..--------------/--..-.-..-.....--------------------------`--` <br /> FINAL INSPECTION BY:. . `_._-_ �.'1._./..--.../ Date..... - -Y"" .^...................---.-.--............-... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stecla rr,California Ladi,California Mantissa,Califarnia Tracy,California <br /> f P.LO. <br />