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" APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> . .. _F. ..y. — --_- a —•. Y � - �� +�—,r,��=rtia� _ ._ __ <br /> Application is hereby made to the San?Joaquin Local Health District for a permit to construct and install the work herein described. 9 <br /> This application is made in compliance with County Ordinance No. 549. '�... (.�{b i <br /> JOB 'ADDRESS AND LOCATION. !. 7` -- l- «' <br /> / � a q <br /> r s Name---^1-U " <br /> 'C - = :__._ TL Phane � _CI_ f <br /> AOdde` - <br /> ass_ __ar ----------------- ---_---------------- --•-----------------•- <br /> -------------------------- <br /> Contractor's Name___---.-. . <br /> - -------- <br /> Contractor's ---- 3 .- -------------- ❑ . Phone----------------------------------- <br /> Installation will serve: t Residence [✓Apartment House ❑ Commercial frailer Court Motel ❑ Other ❑• <br /> Number of living units: IP-Number of bedrooms _ _____ Number of baths` <br /> at size ----------------- <br /> Water Supply:"Public'.system' E3-Gammuniity 'system ❑ Private ❑'. Depth to Water Table --------- ft, <br /> Character of soil.to iaJdepth of 3 feet, Sand Y❑�Gravel ❑* Sandy Loam ❑ Clay Loam ❑ Clay;❑'-_'Adobe Hardpan ❑ <br /> Previous Application Made: Yes F-1Nb:.�.New Construction: Yes ❑ No FHA/VA: Yes E) �«No �e <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �;, ,�tl,e „�,,."_� , <br /> (No septicVY ..- u <br /> Septic ank: teDkstance"rroml npeares welf p bli F�Distancavailable <br /> af�a lefou da wit hin 200 feet.) Mat n I . --- t__._______. <br /> No. of co mpartments_____.�--_____- Size_' ?� _ --=Liqu.id.de th_ _-_ <br /> Capacity F <br /> Disposal Field: Distance from nearest welff..lDistance from foundation--- �------W3dthcoftrenchs�,�, '17e <br /> [ ;Number of lines--------�- - - Length of each line-----___- -�,- "_"-. f --------- -:---- ''i <br /> "'Type of filter materialp g 4 <br /> 1_De tfi of filter material____ _____ ---._-Total len fh___. ___________ <br /> Disfance to nearest w Il ,stance f ndat,on.............:...... fa ,ee fo neparest lot l ;' <br /> �T / J _ <br /> Number of pits____ Lining-material___ Size: Diameter__ _ De th___ ____ �1 <br /> Distance f3om n ar aawell_________________Distance from„ _+ --------------------------- <br /> Cesspool: .# <br /> �Sf <br /> Size: Diameter------------- --------- ----------F-De th----.------ ,foundation ------fir-h�i uid, Cap ity- _.___-__-__-__________ ^ <br /> ❑ r ` --- P 9. P gals. <br /> Privy: Distance from nearest well---------------s------------------------it-----Distance from nearest build nq'-'!-----.-------------------i__________. <br /> Distance to nearest !of lin ;- - ----------- -------------------------------- <br /> ------------= ------------ -- --------- <br /> Remopleling and/or re airin (des ibe): _ _- �+��,.-___ F ...- ""-- ___________� <br /> ' - - ---- - ---=-------- ---------------- -- - ----- <br /> E <br /> j- . <br /> 1,here by,certify that I have prepared +hi pplica+ion a d that the work will be done in accordance with San Joaquin County <br /> ordinance$ a laws, and rules as is ,ons of +he San Joaquin Local Health District:°: <br /> (Signed).__ ____(Owner and/or Confracforl <br /> a . <br /> .. =-:--•--•-- j----------=------------------- == <br /> -- -----"-- ---------"------"------------ --- ....................-------(Title) = - ------------------ t----------- t <br /> (Plot plan, showing size of lot; location of system in relation to wells, buildings, a+c., can be placed on reverse side). <br /> � FOR DEPARTMENT USE.ONLY--,_.��.-.�;. <br /> APPLICATIONACCEPTED BY---------------- ----- - - --------- --------- -- ------------ - ---------------- DATE---------- ---------- ----------------- <br /> REVIEWEDBY-------------=--•------------------------- =--• � - �-`�- ------"T=� ----•---±--- -------';-------.. DATE__��_ -�-�3---�-,--- ,I----------- <br /> BUILDING PERMIT ISSUED________________ DATE.______ <br /> I ----------- <br /> Alterations and or recommends+ions:__ ____ _ 8� ------- <br /> i <br /> ,___... <br /> i.. :. Ck1R `._ ..k_ <br /> - - d - <br /> -• -TO------•--- 'K--- i � - t --------- <br /> -A------- T`'�- =__--"--------�---` ( 1 --�- r ---------- ._ -.. ". _ .C�" ------------­-,--..------ <br /> r __ O r <br /> ---------=-----`------------------------- = ---------= _ -------- ----- <br /> FINAL INSPECT BY: Date -----------------------+ <br /> i n <br /> QUIN LOCAL HEALTH DISTRICT <br /> l I <br /> 130 South American Street X30 v Vesf�Ol. Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California odi, Cali rnia Manteca, California Tracy, California <br /> ES-4-2M Revised 1.57 F.P.CO. <br /> r , <br />