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FOR.OF—FICE USE: <br /> --------------1_n�--------- ----------------------------- R <br /> APDL-le Permit No. <br /> ------------------------- ------------------------------- MiON'F'OR SANITATION PERMIT . ...... <br /> --------- ----------------------------------------------- (Complete in Duplicate) <br /> ------------ ------- ---------------- -------------------- This Permit Expires 1 Year From Date Issued' i Date Issued --- <br /> Application is 4ereby'made to the San Joaquin Local-H-ealfUistrict for a permit to construct and install the work herein described. <br /> This application is made in compliance wit un7f Erdin <br /> JOB ADDRESS AND LOCATION-- ------- ------- -------��A�9E__-__A H-=------ -VV-ET.H <br /> Owner's Name-------­-1-4-0-y-'a---------rmuj(;��H q_T_-__r---------------------------------------------------------- ---------- -- Phone__.,!�m, <br /> _13 <br /> .....0 <br /> Address------------------ -----=-P! P.LjqK------Av-F__,......_ - _R ..... ----------------------------- <br /> Contractor's Name.....63!�IliUZ-- -------------------------------------------------------------------•------------------------------ ------------ Phone---------------•------------------- <br /> Installation will serve: Residence [Apartment House E] Commercial [] Trailer Court [3 Motel [] Other E] W CH FL K F!t4 rs <br /> Number of living. units: -j----- Number of bedrooms Number of baths j---- Lot si,eL_7 _X__1 0 ------------------V-0- A---01-1-10^1 <br /> --- -------- <br /> Water Supply: Public system El Community system [-I Private El Depth to Wafer Table�13 ft. <br /> Character of soil to a depth of 3 .feet: . Sand R Gravel E] Sandy Loam Z- Clay Loam El I Clay El Adobe [3 Hardpan F] <br /> Previous Application Made: (If yes,date---------------------) No 0- New Construction: Yes Y!I'-No E3 PHA/VA- Yes D No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic !Fa-nk'c)r-cesspool-permitted if public sewer is-available within 200 feet.) <br /> PreAo, <br /> Septi T nk: Distance from nearest well..-- ____Distant from foundation----/0---------Mafe,/riI___,R_E_1.)k�b----- <br /> L Liquid clepth___9�;�!7—------Capacity--- <br /> No. of carripartmen'ts-------2-------------Size-- <br /> Disposal Field; Distance from nearest well-__5_Z)_____Distance from foundation-----_10-------.Distance to nearest lot line----,5-------- <br /> Is <br /> Number of lines-------/-------------------------Length of each line---------7-19 -------Width of trench------3 36- 7------------- <br /> Type of filter maferial�5----AROI�K[Deptfi of filter material-------t7..........Total length--------------7 ---------------_ <br /> Seepage Pit: Distance to nearest-well----------------------Distance from foundation--------------------Distance to nearest lot line------------------ <br /> ElNumber of pits-----------------------Lining material---------- --- --- ----Size: Diameter_-----:------_---------Depth-----..--...--------------------- 00 <br /> Cesspool: Distance from nearest well-----------------Distance rfrom foundation Lining material-__,_._---------.--.----------__-_-_ :3� <br /> 0 Size: Diameter------ -- ------- ------------------Depth---- -----------------------------------------------Liquid Capacity_ -------------------------gals.. <br /> Privy: Distance from nearest wolf-----.-__ - ---------------------------Disfance from nearest building__.-------.-------------__ ----- <br /> ID Distance to nearest,lot line_-_--.--_- ---- ---------------- .11 M <br /> ----------- --- ---------------------------------------------------------------------- - ----•-------------------- <br /> 411- <br /> Remodeling and/or repairing --------15--upp-R__ _C!;� --um--------- <br /> . <br /> 6------non p_=t <br /> �_r_I>------- ___ ------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------- ------- A f .1 , <br /> - ----------------------------------------------------------------------------------------------------------------------------------------- ID <br /> ---------------------------------- ---------------------------------------------------------------------------------------------------------------------------- <br /> -------------- ------------------------------------------------ <br /> i <br /> I hereby certify that I have prepared this application and that the work will be done in �ccordance with San Joaquin County <br /> ordinances. S t laws, and rrulp and regulati of the San Joaquin Local Health District. <br /> _t_and �.nj <br /> ------ ------------ ------ -------------------------------------------r------------------------(Owner and/or Contractor) <br /> (Sign( ____#-- ----------- <br /> By---------------------------------------------- -------------------------------------------- ----------------------------------- --------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can -6e.placed on reverse side) <br /> FOR DEPARTMENT-USE ONLY <br /> APPLICATION ACCEPTED BY--------- ---------------------------- ---------------------------------------- DATE---------------------------------------S----------- - <br /> REVIEWEDBY-------------------------------------------- ------------- ----------------- --------------------------------------- DATE----------------------------------------- ----------------- <br /> BUILDINGPERMIT ISSUED------------------------ --------------------------------- --------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations:_----------------------------------------------------------------------------------------------- ----------------------------------------------------------- <br /> ---------------------------------------------------------------------- ------- ----------------- --------------------- ---------------------------- ---------- ------------------------------------------------*---------- <br /> ------------------ --------------------------­ --------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- <br /> - ----------------------------------------------------------------- - --------------------------------------------------------------------------- -------------------------------------------------------------------------- <br /> --------------------------------------- - ------ ------ -- - ----------- ------- --- 1---------------------------------------------------------------------------- <br /> FINAL INSPECTION - W­4_�_�__,- ----- ---- ---- -------- Date---- . ..-_,. .. ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.001 <br />