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FOR OFFICE USE: <br /> ---------------------44-_.___.:-----.---.-----------._._ <br /> APPLICATION FOR SANITATION PERMIT <br /> y . , Permit No. <br /> -------- (Complete in Duplicate) Date I 4 <br /> -------------- Issued <br /> _. <br /> Issued <br /> /r� <br /> _ This Permit Expires 1 Year From Date <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 Ordinance No. 549. <br /> JOS ADDRESS AND LOCATION...______ . _ �_.___._ -_ _____---� <br /> _ •.___._ <br /> 17 <br /> Owners Name---- t �p ----- ------ Phone------------•----------------------- <br /> Address-_ . 7` !- <br /> Contractor's Name h141 - C [ -- - -:P!?i1/?- ------------ Pilone <br /> Installation will serve: Residence [�partment House E] Commercials ❑ Trailer Court [❑ Motel ❑ Other ❑ <br /> Number of living units: __7--_- Number of bedrooms _Number of baths.-./--- Lot size ------- <br /> -------- ------------------------------- <br /> Water Supply. Public system �mmunify system E] Pri Private-E'] Depth to Water Table.�V_ ft 3 <br /> Character of soil to a depth of 3 fee+- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: {If yes,date------------------- ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑. No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public spwer is available within.200.feet.) <br /> Septi Tank: Distance from nearest welL9 _ __...-'Disfance/from/{oun �_®........Material ---_-_- .._--_.--- <br /> P No. of compartments--.2 -----------------Size�,?C-�- - iquid depth....���_..Capacity-__._-XP_���, <br /> Dispo I Field: Distance from nearest well. •Distarice'from foundation-__/0 ...._.Distance to nearest lot line) --__-- <br /> Number of dines__ ______ _____ _____________Length of each line__..��D-f f�.__-:_.Width of french----- -- e_-or __.__--- <br /> Type of filter materia __ Depth of filter material 1-.q.............Total length_-..__.-.__�-. zo----__3-------- <br /> Seeps e Pit: Distance to nearest welln4, <br /> _�� .._....._Distance from foundation-1-P-49--L__ ___.Distance to nearest lot line-.__10f <br /> Number of pits---If..........------1 Lining material.RO& . . Size: Diameter--,--5.-5----.---Depth----ZZ-'-------)____-.._ <br /> Cesspool:. Distance from nearest well .___- _Distance from foundation_________________ __Lining material___._._----.-_.._____._.---------- <br /> ❑ Size: Diameter- -- --------- ----- --------- -----Depth------ -- -- ----- -------- - - --- -----Liquid Capacity-- ------------ ---------- <br /> Privy: <br /> ---Privy: Distance from nearest well________. y_------------------------------____Distance from nearest building-_ ------_---_--------------._._ __._ <br /> ❑ Distance to nearest lot line - ------------------- ---- ----- --------------------------------------- ~. " '------ ---- ----- ---- <br /> Remodeling and/or repairing (describe) _ .____ <br /> -------- <br /> + -- -- - - <br /> --------------------`--- ---- ------ - --• - - - ---- - --- �rte'-;'� -- -� -- -_- <br /> ------------------------------ --------------- -------------- ------------- --------------------------------------------- ----------------------­---------- ----------- <br /> - - ----------- ----- --- -- --- -- - --------y'kt'------- `-- --- ---•----- '",.-----y,------------------------- 1------------- -------- -: �------ --------------------- <br /> 1 hereby certify that I have prepared this application and+hat ive' work will be .done in..bccordance-with-San Joaquin County <br /> ordinances, bate laws, and rules and.-regulati s o Sari' �'aquin LockfHeatth Disfrict,, ' <br /> r � 1 <br /> (Signe --- ---- � ~f 'r ----- - ----------- --- -- Contractors <br /> By --------------------------------------------' --- -- -- -------- ------ ------ -----(Title)--------- ----- --- -------- - - ------ <br /> (Plot plan, showing size of lot, Iota+ion of system in r fion to wells, b Idings,�efc., can be placed on reverse side). <br /> 1 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B -- ----- --`" /5 - .......- - -- ------ ------�---------------------------------------- DATE-�- --- <br /> REVIEWEDBY------------------------- - ----------------------------- ----- DATE--------------- --------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -- --- ----------------------------------------------------------------- ------ DATE------------------------------ ---------------------1------- <br /> Alterations <br /> ------------------;------- <br /> Alterations and/or recommendations.____...............................I_.,_......_..--- ----------------7--------------------------- <br /> ---------- ---------------------------•------ ------------• --------- --- ---------------------- -------------------------------------------------------------- --------------- -- ---------------------------------- <br /> y <br /> x <br /> FINAL INSPECTION BYL� I- ----------- <br /> Date-../5------4----(-:,-.7-- <br /> - . <br /> 6 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> tf <br /> 1401 E.Hazelton 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 />