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FOR OFFICE USE: - <br /> jpo G - <br /> - <br /> ----------- ------------ -- APPLICATION FOR SANITATION PERMIT Permit No. .173_41_ <br /> -------- -------------- Y (Complete in Duplicate) --'of/ ,' _ �. <br /> This Permit-Ex ires 1 Year From Date Issued Late Issued "„ �cribecl.Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de <br /> This application is made in compliance with County Ordinance No. 549." <br /> z - <br /> JOB%ADDRESS AN CATION._Y0' __=-- -l�t7- -27 <br /> ,sem <br /> �T <br /> Owner's"Name-------._._ - ----- - �---• .. � �'' . <br />" 3 C <br /> rt ------ Phone?/Z3= iW <br /> Address--------------•------- � . 0 <br /> Contractor's Nam�a <br /> - � ` <br /> = �c � Phone" LaafS. ----- <br /> installation will serve: Residence Apar ment H ❑ C er ial Trailer CoJ rt ❑ Motel ❑ Other ❑ <br /> Number of living units: _" Number of beds . '-" Number of b s � <br /> i <br /> ------ Lot size _!"'`�---��---�-�-�..---�-----� ----- <br /> Water Supply: Public:system ❑ -Community system ❑ Private 1221"Depth to Water Tableft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay"❑ AdobeeHardpan ❑ <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 sewer is available within 200 feet.) <br /> Septic Tank-V Distance from nearest welllee.......Distance .from <br /> fou dafion--. Material l/--- _ <br /> --:-----------No. of compartments-�-- •---------Size-44 _�`C 1 q Capacity- <br /> Disposal <br /> p YDisposal { <br /> Field^ Distance from nearest well_�l�t!)-�...-'Distance from foundation--- �----_.__Distance to nearest lot line--- rn-_ 11 <br /> `� Number of Innes -. """." l4fl -�,, <br /> Length of each r4fel _100�of trench------ -------, --- --" -_ <br /> Type of filter materia q__-_Depth,of filter material---_-"� - � Total length""--.." Qe�G- �-------- <br /> See pa e <br /> Pit: Distance to neare well-/-601 <br /> --"""Distance from f u dation__ <br /> ".Dls#ante to nearest lot Ein ------ <br /> r <br /> _""" <br /> � �p° ��j <br /> Number of pits" ---------"-"--Lin g material ___ Q"�1--Size: Diameter_ De th---- <br /> r _21 <br /> p , , ..- <br /> Cesspool: Distance from nearest well-----------"""-"_Distance from foundation---- 7--------- ---.Lining material---------------- <br /> --------------------- <br /> El Size: Diameter------------------------------ <br /> ----Depth- --- ---------------•------- ------- - ---------Liquid Capacity-----.---------------------gals. �l i <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest.building .L <br /> --------------- --------------- i <br /> ❑ Distance to nearest lot line----------------------------- <br /> Remodeling and/or repairing (describe):"- -- _ I <br /> ------------------------------------------------------------------- <br /> --------- ---•------•---•------------ 0 <br /> •. --•---------•------------••- --- -- <br /> -------- -------------- --------------------------------------------------------------------------------------------------------- -------------------------- <br /> I �- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r <br /> .ordinances. State laws, and rules and regulations of the San Joaquin Local ealth District. <br /> d <br /> t - - +°---f- -� <br /> (Signed �� +r- t ---- ----- ontrac+or) I <br /> By:----------------------------------------------------------------------------------------_---------- (Title)---------- ----------- <br /> (Plot - ::.. <br /> plan, showing size of lot,.loca+ion of system in relation to wells, ildin s, etc.,/can be laced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEDATE_ <br /> PTED BY---_.---- <br /> REVIEWED BY a ---- <br /> --- -- - -----._.. DATE <br /> BUILDINGPERMITISSUED----------- --------------------------------------------------------------------------------------. D4TE------------------------- <br /> ----- . ._ <br /> Alterations and/or recommendations:___---.._- -P. "_-_ <br /> -------------- <br /> ------------- ------- -•---.. • -----------------•- - <br /> --- -------- <br /> -------------------------------------------- <br /> FINAL INSPECTION BY:- <br /> ------ ---------------- - Date----- <br /> ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 91h Street ' <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> FS 9 REVISED 2-59 3M 3-'63 F.P.0 D. <br />