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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> d--X1 APPLICATION FOR SANITATION PERMIT Permit No. _ <br /> ---------------------I--------- --------- (Complete-in Duplicate) <br /> Date Issued -Zrl7.=_�7 <br /> ---- --------------- ------------ --- This Permit Expires I 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. <br /> r <br /> JOB ADDRESS OCATION ��. .--- ._1�.Q.[,4J ------------•------------ <br /> Owner., _ / q <br /> 's Name ------- --------- PhoneAta --1 115- ---- <br /> Address- <br /> --- <br /> Addres-----///------ -- ------` ."- `i <br /> ----------------------------------------------------------------------------•----------------------------------------- <br /> Contractor's Name- -.-A--- .: r a - �`i° ------------ ------- ---- ----- -- • •----- Phone------ •-------•--•---------------- <br /> knstallation will serve: Residence,® Ap rAll ment House ❑ Commercial E] Trailer Court E] Motel E] Other ❑ <br /> Number of living units: A----- Number of bedrooms -2..-.. Number of baths ---- _ Lot size - ------- ------------------------ <br /> Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table 40, ft <br /> Character of soil to a depth of 3 feet. 'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ <br /> Previous Application Made: Ilf yes,date.,44.------- ) No New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No [k <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:— � \a <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation....................Material ----------------------------------------- ----- <br /> ❑ No. of compartments--------------------------Size-------------------- -----------Liquid depth--------- Capacity------ ---------------- <br /> Disposal Field: Distance from nearest well------.------- Distance from foundation---1 r.-_....Distance to nearest lot line--'Z7.'--..._. <br /> ® Number of lines.---__----.I.. ._..------.-..__.-Length of each line-- 420-" �_-_Width of trench-__. .4 H--------------------- <br /> Type of filter material--l�4Q'- ----- -- Depth of filter material__._.-8_A--......;ofal kength.____-�Q-�-----------------__------ <br /> t <br /> Seepage Pit: Distance to nearest well___'...............Distance om foundation---A4---__--_-..Distance to nearest lot line..J..'..-.-.-- <br /> IN Number of pits.-- ._�..------------Lining material---� L'..�------- Size:'Diameter--- 3.''-- -.----- Depth- ----- .�5-- ----.. <br /> Cesspool: Distance from nearest well ----------------Distance from foundation....------------- lining material------------------------------------- <br /> El Size: Diameter- -- ----- - ----- - ------- -----Depth---------------------------------------------------.Liquid Capacity--- ------------------------gals. <br /> Privy: Distance from nearest well.... --.- .........Distance from nearest building_---.--.--.____._.--------------------- <br /> [� Distance to nearest lot line--------r----------------------------------------------------•----------------------- <br /> ( <br /> Remodeling and/or repairing (describe):. --- '+ � � -� - <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)..-D1 ­A..A4&- 5alJ --------- ------------------------------------------ --------- - - ----------- --------(Owner and/or Contractor) <br /> ' -------- ------- -- --- -----------------------------------(Tif le)----------------- <br /> - ------------------------(Title)----------------- - ---------- .._....-----...---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY = = -------------------------------------- DATE.-'V'—./Z-=_ &7 1 <br /> REVIEWED BY----------------------- --------- ---- ---.. DATE---•------------------------ <br /> BUILDING PERMIT ISSUED-------- -- --------- - --------. DATE- ---- <br /> Alterations and/or recommendations:_ � � __'�--. > .'---•------------•---------------------------------. � ' <br /> -------------------------------------• --------------- ------------------------ <br /> .. <br /> FINAL INSPECTION - - - - Date --- j- ----------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Slockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> \ r <br />