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FOR OF CE SE: / p //�, ! <br /> - � - ��-." ""-_ 3 APPLICATION FOR SANITATION PERMIT <br /> Permit No. ..---•------- <br /> ---- <br /> (Complete in Duplicate) Date issued <br /> y3--G-�--- <br /> -"--"---"--- ------------_-- "---------------- <br /> " ` This Permit Ex ires 1 Year From Date Issued <br /> tion is hereb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> App;ice Y <br /> This application is;made in compliance with County Ordinance No. 549 <br /> ----------•------•--------•--•-----------•----- ---•------- <br /> T10 <br /> JOB ADDRESS AOC <br /> - <br /> Phone- <br /> µ -- <br /> - {:_' <br /> Owners Name __ <br /> f --------------- <br /> ----------------------------- ------ <br /> Address - , _._. e----•----•-------•------------ <br /> Phon <br /> Contractor's Name_-""_'- "- -"_--- Trailer Court ❑ Motel °[] Other ❑ <br /> ate' ®� artment House ❑ Commercial ❑ <br /> Installation will serve: 'Residence- t ^Ap- � x`� "-••________________"_---..--- <br /> . Number of baths _ .. Lot 'size . •--.` f Y <br /> Number of living units: __ Number of bedrooms _ �ft <br /> Depth to Water Table -- <br /> Water Supply: Public system [�] Community sy tem Private ❑ Dep Clay <br /> Loam Clay Adobe Hardpan ❑ <br /> �Gr'avel Sandy Loam ❑` y ❑ Y ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ . ❑ New Construction: Yes .o ❑ FHA/VA: Yes [ o ❑ <br /> Application Made:; (If yes,date------------------ <br /> Previous - l No [!�� <br /> ND SP <br /> TYPE OF INSTALLATION AND� i <br /> (No septic tank or cesspool permitted if public sewer.is available within 200 feet.} �. <br /> le!9---- "-.M tefiai-.. "- t. <br /> Septic Tank: Distance from nearest well-- ""•Distance�rgm foundation__" - / Ca acit -- --- <br /> Septic Size_ Q- Liquid depth-- %y p Y <br /> l!�' <br /> No. of compartments---_-- --------- - -` <br /> "�• lnn___ Distance to nearest lot line--h ---• ..� <br /> _ Distance from fou`ndation___--._ ----.Widthof trent ---------------------------- <br /> n th of each.line_-- -- <br /> Disposal Fi Id: Distance from neares well:" - g f <br /> h---- <br /> Num$ee of`lines--------- ----.. /, nn <br /> -'.-Total length �J <br /> Type of filter'mate ria;--,` �-.0- -_epth`'of filter material`--_� ------ 1 <br /> t a <br /> .Dist rice one rest lot lin <br /> Seepage.Pit: ..y; Distance to nearert;weIL_""----_•_-=---- 4-1 <br /> -Distance fr �fou�idation"-- •---• pe th-- ���---- x" <br /> Linin material-_. I.�v-Size: Diameter-��-------- P <br /> -Number of. pits, 9 s <br /> Cesspool: -.• Distance from nearest well__--------"-"-._°Distance from foundation-_-._---_"._----"---Lining material_-._"--"-""""-------------------••--- <br /> -Depth---'----------------------------------------------- <br /> ---•--------------- -- -- ---------------- Liquid Capacity ---•----•------------gal . <br /> ❑ Size: Diameter„--- •----••--------- <br /> - Distance from nearest building--------------------------------, -- <br /> Privy: Distance from nearest well ----------------.-------- ---- ---- -- .y --------------•---------------------- <br /> ❑ Distance to nearest o ine"_"--_-,_"-."--�_ <br /> ------ <br /> ------- ---- -- <br /> --•-----•-------- -------- <br /> iRemodeling and/or repairing (descn e : , -------•-'--------------------"------------------------------------------- <br /> ? -----------------------•---- <br /> -------------------------------- <br /> = .- ....... <br /> - <br /> ' --------------------=-•-------- = <br /> prepared this application and that the work will be done in-accordance with San Joaquin County <br /> I;hereby certify that I have prep Pp <br /> ordinances, State laws, and rule and regulations of theiSan.,Ioa.quin Local Health-District. <br /> Contractorl <br /> ---------------- <br /> ---------- - --- - <br /> - --- --------- <br /> [Signed} - <br /> -- -------------- (r#le} -------- ---- <br /> --------------------------------------------------------- <br /> By: <br /> build'+rigs, etc., can be placed on reverse st e. <br /> (Plot plan, showing size of lot, location of syr#e relation to wells, <br /> FOR DEPARTMENT USE ONLY <br /> l— 3_ <br /> DATE----- ----''-q--- ---•----------------------- <br /> APPLICATION ACCEPTED BY_-_- r-- ----- <br /> DATE------------------------------------------------------------ <br /> --- <br /> REVIEWED BY-------------------------------------- ------•-------•------- It -- ------•----.DATE.----------------------------------------------------------- <br /> i . <br /> BUILDING PERMIT ISSUED---•-------------------------- - -------• - -------------------------•----•---------------------- <br /> Alterations and/or recommendations............. ­=-------- - ______---"----- ------------------------ <br /> --- <br /> ---------------------- ---------- ------- <br /> ---•------ <br /> t - - <br /> Date 1.-.r"`�: ' --------------- <br /> FINAL INSPECTION BY------ --=-------=--= <br /> � - _ . <br /> SAN',JOAQUIN LOCAL HEALTH DISTRICT <br /> ti <br /> \N ' il 1 205 West 9th street <br /> v 300_west Oak Street ' 124 Syca*,,, �s'Stye,I <br /> Manteca, <br /> 130 South American Street 's � �'' California Tray,California <br /> Stockton,Califarnitr Lodi,California y <br /> EB•9 REV Ifi EO fi•59 F.P.Ca.SM 6.67 <br />