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/'] f FOR OFFICE USE: -------------- -.-L ff-.-------- ------------- --- - APPLICATION FOR SANITATION PERMIT Permit No. 1-101 (Complete in Duplicate) ------- J-•� ------. -...-. i This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per it to construct and install work herein described. This application is made in compliance with County O ce N . 54 . ADDRES D LOCATION.. _.1 V x- -f--1 - ----- ar± ----------------------------- JOB '......... Owner's Name? �t /�1�' ----- Phone-- s -- �-- Address--------_-------------- -----l � �`' Contractor's Nana ? � �- .---- -- --••- -- ------ =- -��------ - _-`'�.-. Phone-----------------------------------T installation will serve: Residence M--A_`pr{ment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -T_ Number of bedrooms ---2--Numberr s of baths _I--- Lot sizep-_--:�-.`-�`�------ ---------------- Water Supply: Public system W_<ommunity system ❑ Private n Depth to Water Table- ft. Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------_....) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is �istance from nearest _well--------------- Distance from foundation-_-------------.--.Material...-_--.---.-.-----..------__.-----..----------. �4"�] No. of compartments--------------- ----- - --Size--------------------------------Liquid depth------- ------.Capacity...--------•----------- D' sal eFF ld Distance from nearest well_ ---------_---__Distance from foundation--------------------Distance to nearest lot line------------- (� Number of I'rnes-----------------------------------Length of each line--------------------------..-.Width of french------.-------------------------.-- Type of filter material-------------------------Depth of filter material_____:____.----------..Total length------------------------------------------ Se ____--_-__--------- .----------------A.Se e P istance to nearest well-- 0--)-0-----Distance}-om foundation__(--Q-_-.___.Distance to nearest lot line--.--�--_ Number of pits ( -------- 9 p , / .. R z.1'ad --Linin material__._ rb -•-...Size: Diameter-_- ..__-__-_De to-_-- -----__.__---.--- Cesspool: Distance from nearest well-----------------Distance from oundation-- r----- ---------- material--.-..------------_________-__-.-.-. ❑ Size: Diameter--------------------------------------Dept h-------- - --- ------------------ ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------- -------------------------Distance from nearest building-.--------.----------------------._------ ❑ Distance to nearest lot line-- ----- -------------- ----- ------------------------------------------------------------------------------ --------- Remodeling and/or repairing (describe)=--------- - ---------------------------------------------------------------------------------------------------------------- 5;4 - . --------------------------------------------- �iL ----------------------------- ---- ^ �---------•-- ------------------------------------ ----------------------------------------------------------------------------------------------- ------------------------------------------------•------------------------------------ -- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.... I hereby certify that�}�aye prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a ules and regulations of the San Joaquin Local Health District. a[ 'l & nq4 (Signed)-------SirPTEC 'T:ai�i1C ---------------------- -------- - ----- - a �r Contractor) B 2915 E.Miner Aver H0.6 X841------------- - --------- Title------ -------- --- -------- - ---- ------ (Plot plan, showing size of lot, location of system in relation to w IIs, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ------- ----------- ----- DATE --�,�r6 REVIEWEDBY-------------------------------------------- ----------------- ------- ----------------------------------------------- DATE------------------------- -------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ -------•_-------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------- -- ----- ------ ---------•-----------------------------------------------------------------•-----------------------•-------------------------------- ----fid:- S - -v7Arh. sur .. ----------------------------------------- .............. l° ,r. --t-c -------------a------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------- ----- ------------- - -•------- -------- ------------------------------------- ---------- ------ -------------------------------------------------------------------------------- FINAL INSPECTION BY:- --- --- -�'!_------------------- ---------- Date---Z49r,'�S.7-_6�,--------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sfoekfan,California Lodi,California Manteca,California Tracy,California F.P.0 O.