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FOR OFFICE USE: � a ---- ------------- - -- ---- --------- APPLICATION FOR SANITATION PERMIT permit No. ., _$ � - ----------- --- -------- {Complete in Duplicate) [rcn.1.E-��G'_ • Date Issued _j72 -_ --------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. .ZGS� COd -f yrs ' Soo • `� , JOB ADDRESS AND LOCATION© i9fill---Z-6 ETRE- -izc+� ; -- a61AP0 —00/4... Owner's Name cm-[,`n-I.# -----------R_O_( `-t ---------- -r--- - ----- ----- --' - ------ Phone Address---- 95-7-0-0----- --19P I CJ D--------P.R----------- ----- 5-----=--------------------------•------------------------- Contractor's Name---0/410114V------ rN2!- _�--------PtPJl� __I—Ar Phone.&V`J.7±< Installation will serve: Residence 25'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 of living units: -1— Number of bedrooms ---/---- Number of baths °= Lot size -- �&F------------------------------------------ Number Water Supply: Public system ❑ Community system ❑ Private ®Depth to Water Table 3,5_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date-.:_--.__-..__-__-.) No New Construction:.Yes ❑ No �A/VA: Yes ❑ No [ TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if:public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well.--.� .._ Distance from kfound ton_ ----/0_-_--_-.�Materia.l«__« E__ .___--.-�'TgNKSNo. of compartments-_-------^2_- ------- Size_, I0 5 ,i-Liquid de .th_ Ca acitY--/57aP_-t-: 1%0 Disposal Field: Distance from nearest well--- .....Distance t1rom non-_-40..___-_-..Distance to nearest lot line__._-5__---__--- N Wid Type of filter materia �-�__-_Depth hofffilter nlmaterial -f S ...-_otalthlength trench 7S1I f._.-------------- r Number of lines---------- of Seepage Pit: Distance to nearest well_._/&9--------Distance from foundation----f6---------Distance to newest lot line.._'-.-.----_ U �_�__----- ---- er_SX-'LP ---Depth ��""==---------- -------- ,r , fp Cesspool: Distance from nearest well-----------------Distance from foundation___-F___ _ material1 ❑ Number of pits..... Lining material- a ,___.Size: DiC; -------Caning ------------------------------------- r{/ ❑ Size: Diameter F- :Depth ------------------------------------------------Liquid Capacity----------------------------gals. '9 Privy: Distance from nearest well ---------------------- Distance from nearest building------------------------------------------ fit ❑ Distance to nearest lot line.----------------------- --- - ------ ----- <------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- _ f'1 _ _------ -----------------------------------------------------AEA ----------------------------------------------------------AEA Lf-}-----A1_&E S------------------------------•------------------- --------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------ -------------------- ---------------- ----------------------------------- -------------------•------------ ------------------------------------------- --------------------------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,State I ws, and rules and regulations of the San Joaquin Local Health District. (Signed)-_-� -- - --- 9 _ ---- --- _ Owner and/or Contract.. 1 �.t��f- --C7------- ---- Title------------------------ - $Y: � 7� ( I (Plot plan, showing size of lot, locatAon of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------�-t Rte- _V-•---- ---------------------------------------------- DATE------ C---•------------------------ REVIEWEDBY----------------------------------- --------- ------ DATE------------------------- ---------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- - ---------------- DATE. -------- ----------------- ---------------------------- Alterations and/or recommendations-------------------------- ----------------------------------------------------------------------------•------------------------------------------------------- ----------------------------- ---------- -------------------------------------------- -------------- ---------------------------------------- ------------------------------------------- :- ------ --------------------------------------- --- ' -- ------------------------ ------------------------------------ ---- ---- --------- - ------- ------------- -------------------- -------------- --------------- ------------- FINAL INSPECTION BY �1 _ Date ---.7-T:f./-.--- - -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stocklon,California Lodi,California Manteca,California Tracy,California F.P.CO.