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FOR CT-FtCE USE: F'` <br /> "7 �. a <br /> .-.....-_�"_'-:_- Permit No. - <br /> --- ----.. <br /> APPLICATION OR SANITATION PERMIT <br /> -- - (Complete-in Duplicate) <br /> -- -------- --------------------------- ------ - <br /> Date Issued -- ---- <br /> --- ---��- 1_ <br /> This Permit Expires 1 Year From Date Issued ) I I <br /> A plication is hereby made to the San Joaquin Local Health District for a permit 0 <br /> to construct'nd install the work herein described. <br /> s. <br /> This application is made in compliance with County Ordinance No. 549. 0}-1 <br /> ---------------------------------------------. <br /> i <br /> ------ <br /> 49OiS ----S- <br /> JOB ADDRESS AND LOCATION______ _ ___ <br /> r <br /> ----•---- <br /> one------ ------ ---------•-- E <br /> Owners Name 1� Cr4U1P0QAI A .1............. <br /> i0 kp• �-_--.-uc---, <br /> O tz ./4NC -------- ---- <br /> Address. _-..__ ) '` <br /> C--- -------- <br /> --- --- f -- ------- <br /> Contractor's <br /> -- . Phone"O �aQ <br /> �� (�+_�A-R2�S'�'�_.._ �.,. �-- <br /> Contractor shlame a ] t .S r` <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trader Cour}'❑ Motel ❑ thea❑ i <br /> Number of living units: '1_---- Number of bedrooms 2---- {`lumber of baths_ ..-- Lot size-__- _ _ t <br /> Community system ❑ Private Depth to Water Table_ ft <br /> Water Supply: Public system ❑ Y Y . t "c Clay Adobe ° Hardpan ❑ <br /> Character of soil to a depth of 3 feet' Sand ❑ Gravel'❑ Sandy Loam ❑ Clay Loam.❑ ,.; Y ❑ <br /> Previous Application Made: (if yes,date3'� � 1 No,❑,w,kNew Construct,ion,: Yes [] ._oX FHA/VA: Yes ❑ No ❑ <br /> OF INSTALLATION AND SPECIFICATIONS: <br /> TYPE - <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F <br /> t <br />! � - � Material --------------------------- <br /> fromDistance from nearest well-. --_ - ---Distance fou- <br /> .�....«Septic.Tank:�,. _ _.,�t. �...�.__�.....,��k.......� Size�. Lic{uid d'ep;th'____� --- nearest I'ty-_ ------- - -- <br /> * ista f compartments___- .. -_ <br /> + / <br /> --------------- ------ E <br /> l Ds osal Field: nce from nearest w L. -. -.-Distance from foundation"_ _:DVdthcoftfirench_-24q,line--_. <br /> 5y __ ; <br /> F Number of lines--------- --------Length of each line-- --- " . 46y- <br /> .-- _ - - lengthJ___ <br /> - ���` ` '�'n\ <br /> ' ~'nce from foundation--_-6-Q-_"""_"-".Dista <br /> f 41 T �,af�-filter material �_" De of filter material____��__ .- _-. _Total Distance to nearest lotTline_.-�_"".--�•�` <br /> YP <br /> Seepage.Pit: Distancd, o nearest well-.-/ ._..- Dista r <br /> ] Number of;,pits_ � __n . --_Lining materia} .Si _ 5iz Diameter.53 k_,5-x _ __Depth -.- . - <br /> _ _4 -- <br /> Cesspool: Distance fiomneanest well _---_.-- Distance from foundation."- k.. ..Lining materia_-. -- # <br /> .. ---- Liquid Capacity� _ ; - -- - gals.' <br /> ❑ Size: Diameter : Depth <br /> , - = rest buildin <br /> Distance from nearest well--- ---- g T ---------- <br /> ---------:!t--;----------------------°. <br /> i Distance-"rom nea�F.1�-�--- - _"-- f s 7 <br /> ----------- <br /> Privy- Distance to nearest lotDne ------------ ---- ----- ----------------- <br /> d p <br /> odelin and or re airin describe :--___ ----------- <br /> -----------------------1,f3llli�- t <br /> _ '----•--------•`------- ------ <br /> Rem g / P g } r � "---------------------- <br /> ---------------- <br /> --- ----- ------ <br /> •� I � _ <br /> -------- r <br /> -- <br /> „_ <br /> ------ <br /> I hereby certify that l have prepared this a�plicafion acid that the work will be done in aecordarice with San Joaquin Count <br /> ordinances, State laws, ane rules and regulations af„the &6'Joaquin Local Health Dtstrict? .""i 1 . "` <br /> i ( �e TO ] E" - f - (Owner and/or Contractor] <br /> i Si ned * A T1 �►22�SH SOO.S- , ------- ---------- -------- <br /> ------- <br /> ------ ] <br /> r ( 9 -- -- -- -- -------------- <br /> �P .w.:.. <br /> sy' """ ` f.: buildings, etc., can�lie plated on reverse side]. <br /> (Plot plan, showing size o0ot, location of system"in relation to wells, ■. { <br /> r --`' FOR DEPARTMENT USE.ONLY <br /> DATE_­__! <br /> ACCEPTED BY_ . ------------------ <br /> " <br /> --- --- ---- <br /> t <br /> REVIEWED BY-------------------- --------------- --- .. <br /> DATEyf:- <br /> } . :_ DATE_----------------� <br /> BUiLDING�PERMIT'ISSUED �a� _ t <br /> e e- <br /> Altera#ions and or re ommendations:_--_ - _ f - <br /> .. Y' <br /> �...o �_. �..., <br /> __"- --------------------------------------_----__._._--.._._-___-_____._ ---------------- <br /> ---------- <br /> . __....-_ - <br /> ___-."_...-"_.--.._. ------------------------------------ ---_."-.__-... <br /> r , , -- �-� <br /> {�7 <br /> w'- Date- .-...."._ --- - . ------------------------ <br /> ------- - --- - --------------- <br /> ------------- <br /> FINAL INSPECTION BY:-.-___-__.__ ._." <br /> "`� SAN JOAQUIN LOCAIHEALTH D15TRlCT — '- <br /> r". 205 West 91h Street <br /> 1401 E.Hasetton Ave. 300 west Oak Street ��; 124 Sycamore Street i <br /> Stockton,California <br /> Lodi.'California Manteca,California t Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press � _—;;,�,�,..•✓-^"'"� <br />