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FOR OFFICE-- --USE-:---------------- Permit No. 4� <br /> ---- - ----- --- ----- APPLICATION FOR SANITATION PERMIT <br /> - <br /> -------------------------------------- <br /> ------------------ (Complete in Duplicate) Date Issued <br /> ----------------------------I--------------- <br /> ------------- <br /> This Peimit'Expires 1 Year From Date Issued <br /> -------------------7 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> -jo-n17-s� compliance with County Ordinance No. 549. <br /> a, <br /> JOB <br /> 1101, ) . 12�- <br /> ATl --------- <br /> ATI. --------7-1--- -----A .- <br /> 31-��o <br /> -------- Phone/�4_a--- <br /> -------------------------- - ---- --------------------------- <br /> ...........-------- --------- ---------- <br /> Owner's Naive------- ...A <br /> 7 <br /> --------- -------------­ <br /> �,_.15......:�---7---- C--- - -- --------- ­-­---------------------------------I-------- <br /> Address...---------- --------------- - ------ <br /> ------------ -- ------ <br /> --------------- <br /> Phone.-----•-------------------- <br /> Contractor's Name---------- -------------- <br /> --- ------- ------------------------------------------------------- <br /> t <br /> Commercial E] Trailer Cour �4pfel 0 Other 1:1 <br /> Installation will serve: Residence Apartment House 0 4 <br /> g ---------------- <br /> Lot size;_PFF/ 14---T------------- <br /> Number ofliving un4sT,.,vj­1 Number of bedrooms Number of baths <br /> ate 0 'Depth to,,Water Table :3� t. <br /> Water Supply: Public sysfe.m`W Community System <br /> Gravel E3 Sandy Loam ❑E]'�,Clay Loam 0 Clay 0 Adobe g) Hardpan 0 <br /> Character of soil to-a,'depth of 3 feet: Sand [I <br /> i -e � ti'n-.. Yes a No 0 FHA/VA, Yes C] No <br /> r Previous Application Made: (If yes,date------ r"NoNew Construction;.g. .,. I <br /> TYPE OF INSTALLAT16N'AND SPECIFICATIONS: <br /> (No septic fank__0`r cesspool 1permitted if public sewer is available within 200.feet.) <br /> ----------------- <br /> 7�It' D�stan6e from 'nearesf-'ell e- ...Matell <br /> Septic Tank: W _.__7Zrj_4,iL.Distance from founclarf)on-,11-6-------- <br /> clep�h-------�q----- ----Capacity-- -- ­----- <br /> No. of corripartmerifs-_.191-------•------Size---.3 <br /> I ---------- <br /> D�sposal Field-, I Distance from near t Weil__-71-&CDistance from founcla�ion..//j -------Distance to nearest lot lin ... <br /> Length of each line--- Width of trench----o24 1 -------- <br /> Number 'ri.s-------I------- ------------------- j <br /> 4 �: _­ I r----Total length------- --------------- <br /> Type of filter materia - ------ epth I of filter material�------------------ <br /> I _.!���__Disfante from foundation-.Ip-. / nearest lot line i6_ <br /> Distance to nearest well -----------Distan5e to <br /> lsv�uvw Pi I!- d <br /> Number of pijs�---/:--------------Lining materiaI4914,��74_ttze: Diameter-*-., epth-------------j------------------ <br /> 41,Y 1.4 k <br /> Cessool: Distance from,near'est-well-:T:-:_-------Distance-fr.o m f0undafion------------- -- - <br /> - ---Lining material --------------- <br /> - . --- - ----------------- '0 <br /> ------ -----Liquid Capacity........­----------­­...gals❑ . <br /> p <br /> Size: DiaTefer---------------------------------------Depth-------!�------------------- ----------- <br /> e - I _-Dis+ance from-nearest building----------- ------------------- ---------_ <br /> Privy.: Distance from nearest well------------_------------------ -------------- <br /> ----------------------------- <br /> ❑ --------------------------- <br /> Distance to_64rest lot line------------------------------------------------------------------- <br /> ------------------------------- <br /> -------------------- <br /> Remodeling and/or repairing r(describe)--------------------------------------------------- ------------------------- <br /> --------- --_------ <br /> I I - t � ------------------ <br /> ---------------_I---------- ---------------------------------------- <br /> ------------------------------------I------------------------------ <br /> ------------------------ <br /> 7 ---------------------------------------------------- ----------------------------------------------------- <br /> ----------------L.-, -------------------- ----------------------- <br /> ----------- ------------- <br /> - --------------- I V � I I"-- . t . ---------------------------------------- <br /> .tr ------------------------------------------------------------------- ------------------------------ <br /> k, ------ ------------------ ---_--------------------P--.---_-.---__•_------•-'------ <br /> I hereby,certify that I haV6 prepared this application and,that the work-wiill'6e done in accordance with San Joaquin County <br /> ordinances, tfate laws, 'and rules and regulations of the San Joaquin".1ocal Health District. <br /> --------------------(Owner amd�or Gon+r4d04- <br /> ----------- ------------------------ <br /> (Signed)---------:-n------ --- ------------ -------------f--------- -------------------------------------------- <br /> i I <br /> _jTitle)--------------------------------------------- ------------------ <br /> By. ---------- ------------------------------ <br /> -- - ------- -- --- -- ---------- <br /> ---- - ----­..of.-system.-in-.-relation.-- -to wells, buildings, etc., can be placed on reverse side). <br /> (Plot plan.-sho -iiie'of lot, to I <br /> FOR DEPARTMENT USE ONLY. <br /> -P DATE.---- ------------------------ <br /> APPLICATION'ACCE TED ----ci -------------I-------- <br /> r DATE----------------------------------- <br /> REVIEWED-,:B.Y--------------------------------------------- -------------------------------------------------------- ------------------ <br /> V :j I --- DATE-------- ---------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------ ----------- ------ <br /> ---------------------------------------------------_--------------------------- ---------- <br /> �- -------------- <br /> -----------------­---- ------ <br /> Alterations and/or recommendations:-------- <br /> ------------------ ------------ -------- ------------- <br /> 1. V r_ 4---/t25 <br /> ZL' ------------------------------- ------------------ ....... <br /> ----------------------------------- ------------------ ------------------- - --------- ---------I------ ------------------- ------------------ <br /> ------------------------------------------- ------------------------- <br /> --------------------------------------:- ----------------------;------------------ ---------------- ------ --------------------I-------------- <br /> 2- -------------- <br /> Daf-------- ---- -- <br /> - - -'----- ---------------_----- <br /> FINAL INSPECTION BY-_e"-_. - ----- --- - ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycaimore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB•9 pEYl9 EO 9.58 r,P.CM.2M 6.613 <br />