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APPLICATION FOR SANITATION PERMIT Permit No- ------------------------ <br /> (Complete in Duplicate) Date Issued --- <br /> A <br /> �plicar�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND L.,(0CAZION__"_e1,9._1Z7 n k <br /> ------4-Ke ---- ----------- --- ---- ----- <br /> ------P_ho`n__� <br /> Owner's Name---------------- f f-- ---------- -------------------------------------------- eA0 <br /> Address---------------........ ............ --- M- -6---------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name------ <br /> - --- -----el n.C�------------------------------------------------------------------------------------------ Phone..--i�V......... -0 <br /> �7 <br /> Installation will serve: Residence D--A-partmenf House E] Commercial E) Trailer Court E] Motel [] Other F] <br /> Number of living units: ---i--- Number of bedrooms ___Y.- Number o baths _/--- Lot size ----0_'_ _/O-4----------------- <br /> Water Supply: Public system El Community system Ej Private epth to Water Table -------- ft. <br /> Character of soil to a depth of 3 fee+: Sand [2' Gravel E] Sandy Loam [] Clay Loam El Clay E] Adobe 2r--H-ardpan E] <br /> Previous Application Made: Yes F1 No l� New Construction: Yes [] No 0 SVq1k1,nen1aPy( <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> -L!qo septic tank or cesspool permitted if public sewer is available within 200 fee+.) <br /> S& Tank: Distance from nearest well______._...______Distance from foundation___________________Material.___-_--___-.____--.___..._____--____._._.___.._. <br /> m - - --- - <br /> No. of compartments------------ -------- ----Size--------------------------------Liquid depth--------------------- ----Capacity_.....---------------- <br /> is osaJr Fiqd:---�--� Distance from nearest well-__ Distance from foundation--------- to nearest lot line_________________ <br /> umber <br /> ine----------------- <br /> umber of lines-----------------------------------Length of each line------------------------------Width of trench---------------------------------- <br /> Type of filter material. —------------Depth of filter material-----------------------Total length_________________________________________ <br /> Seepage <br /> ength-------------------------------_--------- <br /> Seepaqe Pil.' Distance to nearest wt#OY--- ----Distancfrorn fo nd tion-----/4_:�___.Disfance to nearest lot line..____ _ ___ <br /> j p a <br /> Number of its___ .._..__..____Linin material___._ --_Size: Diameter-- Depfh__24.Z7..�*----------------- <br /> Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material_____..______..------------_________ <br /> ❑ Size: Diameter-------------------------- ......----Depth-------------------------------------- --------- --Liquid Capacity-------------------------•--gals. <br /> Privy- Distance from nearest well----------------------------- -------------- ....Distance from nearest building______.__.__.______---- ____--------- <br /> El Distance to nearest lot line---------------- ----------------------------- ----------------------- ---------------------------------------------------------------- ­ <br /> Remodeling and/or repairing (describe):-------------------------------------- ------------------------------------------------------------------------------------------------------------------ <br /> ..........------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ ---------- <br /> -------------------------------------------------------­­---------I-------------------------------------------------------------------------------------------------------------- --------I----------------------- <br /> -------------------- ---------- ---- --------------------------------------------------------I---------------------------------- ---------------------------- -------------------------------------------------------------- <br /> I here certify hat I have d this appli Qn and that the work will be done in accordance with San Joaquin County <br /> pro 0 ' ' 50 <br /> ordinances, State la and rules and e ul'a ons of the San Joaquin Local H 11thn District. <br /> -pal f <br /> rl <br /> T <br /> [Signed)---- -----C T"I-------S- 1------ ------ ------------ ------ ----------------------------------- <br /> ------ ---------- ontractor) <br /> _ - /_ _. I 9r/1 <br /> By:---------------------------------------------------------------------- --- ------- - ...{Tale) .2�j-----//77 <br /> ---------- ------ ---- <br /> _/ - - -0--&---- ---------------- <br /> 0 c.. <br /> ------------- ------- <br /> (Plot plan, showing size of lot, location of syst in rela4io'n to wells, buildings, c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- --- - - - ____ ----- DATE------ --- ------------------ <br /> REVIEWED BY_� ....... <br /> -------------------------- -------------------- --- ---- ---- ------------------- ------ DATE---------- --••--------P----------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------- <br /> ------------------------------------------ ------------------ DATE.-------- - ------------------------------------------------- <br /> Alterations and/or recommendations:--------------------------- -- -------------------------------------------------------- -------------------------------------------------------- <br /> -------------------------- --------------------------------------- ---------­------------------------------------------------------------- ------------------------------------ -------------------------- <br /> - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------- --------------------------------------------------------------------------------------------------------------------------------- -------------•----------------------------------------... <br /> ....*-------*------------------------ ------------ --------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.... _S Date- 4- / g - <br /> ------------------------------------------ --------------- ------------------------------------------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Sfreof 300 Wes+ Oak Street 132 Sycamore Street 814 Norfh "C" Sfreef <br /> Sf*ck+on, California Lod;, California Manfeca, California Tracy, California <br /> EF;__9_2M 1454q6 ATWCOD 12-zg <br />