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FOR OFSFIC USE: <br /> a ------'3G -------------- <br /> E- <br /> ---------- -------------- <br /> ` z <br /> A <br /> PPLICA rION FOR SANITATION PERMIT Permit No. ..' <br /> ----------------------------------- <br /> ------------------------------------------------------- (Complete in Duplicate) <br /> Date Issued <br />---------------------------------------------- <br /> I------------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to,the San Joaquin Local Health District for a permit to construct and 'install tho.work herein described. <br /> This application is made" in compliance with County Ordinance No. 549. <br /> -------------------------------------------------------------------------------- ...................................... <br /> JOB ADDRESS AND1O9j1NTlON.____&.P_0-_7-------CAQ�t � <br /> Owner's Name... -. (........7A1 -1L <br /> ..:..................•-------•------ .... <br /> --------------- <br /> a <br /> ------------------- <br /> Address..........................I.......L S- ............... ------- _-------------------------------------------------------------- ........I....... .................................... <br /> ------------------------------------------------__..... Phone-------*........................... <br /> Contractor's Name------I--------­­­............I...........­­....... . ..;!q.dy. <br /> Installation will serve: ResidenceAL Apartment House El Commercial I-] Trailer Court El Motel El 'Other C]' <br /> 2,_ 41 <br /> Number of livin units: <br /> I. Number of bedrooms -------- Number`of'Qihs ---I/2-Lot size --------- MIZ----:.................. <br /> 9 .i � ir <br /> Water Supply; Publiclp'ystern El Community,systernA-Priyate O-D3Zfh t Water Table .4,4t. <br /> . �k * Idy <br /> Character of soil to a depth of 3 feet. Sand Gravel 0 Sar Loarri� ioClay Loam Clay [3 Adobe Hardpan C1 <br /> Previous Application K4da: (if'yes,date___________ _____}S - �6 4 1 –1 <br /> -- New Construction; Yes 3& No [3 PHA/VA: Yes No F I <br /> TYPE OF INSTALLATION-AND SPECIFICATIONS: 'b <br /> (No septic 4A• �r cisspool ermined if public sewer is available within 200 let.) <br /> --••-•------........... <br /> Septic Tank: Distance from nearest wel[4_ 25�4? .Distance from fc5undation.....................Material------- <br /> 1. <br /> ........... <br /> No! of compartments---------- ------------I_ Liquicl'depth--------P----�!!eJ Capacity.--- -------i AL <br /> Disposal Field: Distance from nearest well__- Distancefrom foundation. -/V ... ...Distance to nearest lot line-_1_..._._.. <br /> V <br /> NAber of lines---------------9____ Length of each line_________d 49 ---.,Width of trench..........1.4.... ............ <br /> X. I Z-P Total / I-— <br /> Type of filter rnaterial_&,P_ALkZpth of filter mate'rial---------- length!_______________ <br /> I <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line.........._...... <br /> ❑ Nuliber of pits----------------------Lining material-----------------------Size: Diameter_.-_.... _..- ........Depth-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------_-------------------------- <br /> EJ Size: Diameter------- ------------------- .....Depf h----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest nel--------------------------------------------------bist;_n(7e_;r_o_mn'e�a"resf building___:._„__..._.__._...._..._.._....._____. <br /> ❑ Distance to nearest lot line_-______ ----------------------- <br /> - ---------- <br /> Remodeling and/or repairing (describ <br /> ---------=!---------------- ---- ------------------------------------------------- ------------------- ........................................ <br /> `'A Q , -N — � -------_-------------- <br /> --------------------------------- ----------------------------------------------------------- ------------_--------------------------- ----- ------------- <br /> ------------­- -------- ----------------------I------------------------------------------------------------------------------------ ---------- --------------------------------- <br /> ` --------------- - ----- 1111 ------_----_-----_-------------------------------------------------------------------------------------------I)-------------------------------------------------- ---------- <br /> �_4 * ------------------ <br /> if have r red this a lication and that the work will be done in accordance with San Joaquin County <br /> I hereby /'eri, y-f <br /> p <br /> S <br /> d r g u�lla f the San Joaquin Local Health District. <br /> I' <br /> ordinances, S a a rules <br /> (Signed)----- = <br /> .............i----- ------ ---------------- -----------f= -------•----------------------------- (Owner and/or Contractor) <br /> B .---------------------------------------------------------------------------------------------------------7-7-i------_-------(T-,+Ie)-j­­:;--------- -------------------------- -------------- <br /> (Plot plan, showing sizJ of lot, location of system iin- r-elation to wells, k;uVj`1n9s, etc., can be pl�ced on reverse side). <br /> • <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED'BY------------- ---- DATE- ---------------------- <br /> 8 -------------------------------------- <br /> --b------3 <br /> REVIEWED BY - <br /> ------------1-------------------............... �. <br /> --- ---------------------------------------- --------------I-------.. DATE.--•--- *--------i.,--------------------------------------- <br /> BUILDING PERMIT I55UED--------------- ------------- DATE--------_--------t---------------------------------------- <br /> ---------- k <br /> ns and --------------------------- ---- ------------ ------- <br /> Alteratio -------------- <br /> --jor recomm n afions: <br /> .............e ......... -------------------------------- <br /> . .. ........... - ----- <br /> ,2�-- - - ------ -- <br /> ------------------- ....... <br /> ......................................I...........................................................---------------------------- -------- --------­;.......................................... <br /> --------------------------------------C----------------------------------- ------------------------------------------------------------ ----------- --------------------------------= ----I ­-------------------------------- <br /> ------------------­------------------- ------------------------------------------------------------------------------------------------------- --------------------------------------- -----------­-------- <br /> N <br /> FINAL INSPECTIOBY' <br /> 1 J, <br /> ate -------------n_------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 12 4 Sycamore Street 205 West 9th Street <br /> Stockton,California LOdIr California Manteca,California Tracy,California <br /> VQ 9 AXVISED 6-89 2M 5-44 ATLAS <br />