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FOR OFFICE USE: <br /> e---------------- /•: .......... <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------------------- --------- (Complete-in Duplicate) <br /> Date Issued --_--��_�_--- <br /> ______________________ __________ ...... .......... 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 the work herein described. <br /> This application is made in compliance with County O,,rd��inance No. 5149. /� f 1 <br /> JOB ADDRESS AND LOCATION...-_/If. .l�o--------!`-_. '----- `7 .�'_!.�_1fri ' <br /> Owner's Name---------Ahlb 1--------G Z-1------ ----------------------------------------- <br /> ------------------- Phone --- <br /> Address----------- <br /> Address----------- ----------- 11 '►.1.---- ' <br /> S `------------------------------------------------- ----------------------�}f -•--•• <br /> Contractor's Name-----------------D-'-A'---- -------------------- • •--------..... <br /> Installation will serve: Residence tg Apartment House ❑ Com`m`ercial .❑ Trailer Court [:] Motel ❑ Other ❑ <br /> Number of living units: __ _�._ Number of,bedrooms- : Number of h`aths -.{r_ Lot size _____ ___ ________ ________ _______ ----------------------- <br /> t: <br /> Water Supply: Public system ❑ Community system ❑ Private X Dep4jo Water Table ------ - ft <br /> t <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam G)ay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_-..._.. _--- No,X -�-New--Co struction:-Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f <br /> septic tank or cesspool permifted if public sewer is available within 200 feet.) <br /> .r. t. r� f , <br /> .. r <br /> eptic Tank: Distance from nearest well-... _-,....pistance from foundation__._�r��..__.___.Mafieriaof...................'..___.__..._.___- __.__. 1 <br /> �'yol k No. of compartments......... -------------Size---_---------:------ - ---_._-_Liquid depth___.-.t57� -- ------4.Capacity--- QO--- -[d- <br /> I ` <br /> p __Distance from foundation1_-_��.-_--_._.Distance to nearest lot line---/Q_t_�� 1 <br /> Dis osal Field: Distance from nearest wells_..:.. :' <br /> Type of f;Iter,material:_t----i_Q ---y.:6e;gh of'f a h line::]. - -------Widthof trench---------- -�7�`------------1-- <br /> Number of lines.____ ___ ____ ____ __ ___`_.'�__Len th�of, <br /> t 3 P alter material---------f-�.------..Total length-'--------- ---7 .... <br /> Seepage Pit: Distance to nearest weir_.__. _'__._ _.,..:' ,Distance ffirbm�fourMation--------------------Distance to nearest lot line----------------- �I <br /> ❑ Number of pits-- ------------------Lin ing%aterials--=---=------------ Size: Diameter-------------.---------Depth------------------------------ <br /> Cesspool: Distance from nearest well _____________ <br /> --- Trom foundation................. ..Lining material-.-._._._-----._._..___-__-----_...._. <br /> F-1Size: Diameter ----�--Depth-.-------'\-�----------------------------------Liquid Capa city------------- ---------------gals. R� <br /> Privy: Distance from nearest well------ --- -----------------------------------'-Distance from nearest building. ----------- <br /> ------------------•--------. <br /> ❑ Distance to nearest lot line ............................. ----- ---------------=---------------' <br /> I = <br /> Remodeling and/or repairing (describe). <br /> _ --------------------------------------- <br /> ---------- <br /> ---------- <br /> . <br /> .______ _______.___._-_.--__ <br /> .________. _ ---__-.-- ---- --__• _ -_-_ -----.}_.---_ <br /> -------------------------------------------------•----------• - ----- -•------ <br /> 1 45 <br /> ' - ____ <br /> ' <br /> r- <br /> R <br /> ----------,-------_______________--------- -----------------------------_ _____.___----------------------.-------------------------------------------___----------------------- <br /> ---------------. ----------- ...... _...,. <br /> I hereky certify that I have prepared this application and that the work willflie�d'one^in,accordan a with San Joaquin County <br /> ordinances,!State laws, and rules and regulations.of the San Joaquin Local Health District.+ <br /> `-%Z4 t+.e i e-St fR i <br /> (Signed) L PA�iloca <br /> YYIS.�Io.M 1*JZC' ' <br /> 9 ) 1 - ----'{Owner and/or Contractor) <br /> gy; -- --- ---- - -------- ------------------------(Titl�)---------'.- I <br /> (Plot plan, showing size oof sysfe"rn"in relation to wells, buildings, etc., can betplacedlon reverse side). <br /> FOR DEPARTMENT USE ONLY i <br /> APPLICATIOWACCEPTED BY.-------------- 00' �- -------- ----- DATE..... �f- +v' -------------- 3 <br /> REVIEWED BY------------- ---------- ------------ <br /> -------- -- - -- -------- - -------------- - ---------- ---------------------------------- DATE- <br /> --- ---------------------------- <br /> BUILDING PERMIT ISSUED-------- -- ---------------------- ------------------------------------------------------------------- DATE-------1-------------1-------- <br /> Alterations and/or recommendations:-------------- ----------- ........... ---------------------------------------------------•-----I1. - <br /> ------------ -- ----- -------------- ------------- -1-J,------------ - ----- -------------- - <br /> ,. }- - <br /> ---------------- ---------- ---------•-------------- ............ ------------------- --------------------------------- ----- ---------- --------------- --------- - ------------------------- <br /> ---------------- ------------------ ------ -- -- - - ----------------------------------- ------------------------- <br /> ------------------ - -- ------- ------- - - - <br /> FINAL INSPECTION BY:_.... .:�_� ------------ Date.---�"..-�-'� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br />*� E.H.9 2M 1.67 Vanguard Press <br />