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FOR OFFICE USE: <br /> ------------19--)Y-_(01--------'4-4 0-H.- <br /> ------------ —6-(....... {�1'r- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _..................... <br /> --------------------------------------------------------- (Complete in Duplicate) Date Issued .................... <br /> .__________________________________________________^_.__ - This Permit'Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Heal+h District for a Permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION----- --r?- ----------- -----------------­--I----------------------------------------­­----------------- <br /> Owner's Name------------ ----------- <br /> Phone <br /> Address-------lell ------------------------------------../: 4eovl -W-------------m----------------------------------------I---------------------------y----------------------------------_-----------.---------.-.-................. <br /> . <br /> Contractor's Name---------------- 0.6 ---------------------------------------------- Phone-- <br /> Installation <br /> will serve: Residence Zj-�Apartmenf,House E] Commercial F] Trailer Court`[] Motel E] Other El <br /> t O& 13 <br /> Number of living units: Number of bedroorns-&--- Number of baths Lot size -----------------7S--- <br /> - -- --------,N <br /> -- <br /> Water Supply. Public system',E] Community system [B-15�ivate 0 Depth to Water Table _�rft. <br /> Character of soil to a depth of 3 feet: -Sand F] Gravel E] Sandy Loam C] Clay Loam ❑ Clay E] Adobe�dpan C] <br /> Previous Application Made: (if yes,date-------------------- No Z2�New Construction. Yes PHA/VA. Yes V- 'No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 2.00 feet.) <br /> • <br /> Se k: Distance from nearest well----.`----Distance from foundation_____le. Material---- -------- <br /> ------------- <br /> Size --Capacity--rle?-49...... <br /> No. of compartments-------- <br /> TIV-------Liquid <br /> 1. <br /> Disposal 'teld: Distance from nearest well-___"-- -Distance from foundation--- -----------Distance to nearest lot lin,�4k� <br /> Number of lines.------ - -- ­-------Length of each line-----70-�--------------Width of trench___ ____.__,A/ -------------------- <br /> Type of filter material/_j_/,C9e-00_D,pth of filter material--/*P:?--------{_Total length-'-.000 <br /> _ `�'­­--------------------- <br /> Seepaq�eyit: Distance to nearest well-____: from foundation____ Distance to nearest lot line__!�r----- <br /> Z?4 Number of pits--------2- --- ---Lining rnaferial---/_0.&_e,,06_S�ze: Di6M_e'ter__ ----Depth_X07�A1"_,____- <br /> Cesspool: Distance from nearest well_______________"Distan.ce from foundation--------------------Lining material__.__________________________.__._._. <br /> ❑ <br /> aterial------------------------------------- <br /> 1771 Size: Diameter------------------ --------------- ----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy- Distance from nearest well------ ------- ---- <br /> --------7----------------------Distance from nearest building-------------------------------------- <br /> ❑ <br /> Distance to nearest'lbt Frie------------------- ------------------------------------------------------I----------------------------------------------------- ---------------- <br /> 00(- 14 <br /> Remodeling and/or repairing (clescrTbe):---------_Wk�- -------- _-----------•----------------------------------------- <br /> ---------------------------*----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ <br /> k-------------I----------------------------------------_--------­------­---..-------------I------------------ ----------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ,ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ,.(Signed,--- -- ------ - ------ - - ------------------------------------------------------------------------------(Ommorinind7tw Contractor <br /> By:----------------------------- -------------------------------------------(rifle)--- -------------- --- ------------------- <br /> (-Plot plan, showing size of lot, iiio�lo system in I relation to wells. 66ildin-g"s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONL.Y--,—.-. <br /> APPLICATION ACCEPTED B -------- ------------------- DATE----- _- -- --------- <br /> ,,REVIEWED BY------------------------------- --------------------------------------------------------------------------------------------- DATE--- ----- <br /> --------------------------------- <br /> '-BUILDING PERMIT ISSUED_ Z ----------------------------- - - _- _ DATE.. I- <br /> -------- - ------ <br /> "K <br /> Z;P _e� -- <br /> Alterations and/or recommendafions:1,4 �_ ----- <br /> -------------------------------------------------------------------------------------- --------------------------------- ------------------------------------- <br /> ­-­-------------------------------------------------------------------­­----------- <br /> ----------------------------------------------------------------------------------------- ----------------------------i-------------------------------:-------------_-------_ -------------------------------------- <br /> ---------------------------------------------------------------------------------------------- --------------------- ------------- ----------------------------------------------------------------------------------------- <br /> ------------ ------------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> FINAL 'INSPECTION B Date---------V.. ----------------------------- <br /> SAN JOAQUIN LOCAL,HEALTH DISTRICT <br /> 130 South ArnibriCarl Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodir California Manteca,California Tracy,California <br /> E13-9 REVIBCD EI.59 F.P.CD.2M 6-60 <br />