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171 *7" <br /> FOR OFFICE USE: <br /> ------------------------------ ----------- SANITATION PERMIT Permit Nc�. <br /> --------------------- --------- ------------------------ APPLICATION- FOR r S <br /> A]------------------- (Complete in Duplicate) <br /> -------------------- ­ Date Issued 77-2.9'1('Z <br /> -------------------------- <br /> 1_- <br /> ------- ----7--- -------------- This Permit Expires I 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 do in corn I- with County Ordinance No. 549. <br /> p ia ce with V< <br /> JOB AD IV/V- - --l--V-=b ....... o--------Al--------- - x <br /> DRESS AND LOCATI5----j3R-04ZO_t�------- .5 <br /> Owner's Name------------i,_.-��----C-'--------WAT-7-SPA--- ---------------------------------_---------------------------------------- Phone----------------------------------- <br /> ------------------------------------------------- --------I----------------------------------- <br /> Address__..--- ------_2-37----------- <br /> Contractor's Name__�WdKf�--------------------------I--------------------------- ---------------------------------------------­-----------z--- Phone----------------------------------- <br /> Installation will serve: Residence E] Apartment House E] Commercial El Trailer A&Wtr+-[Mofel 0 Other E] <br /> Number of living units: r______ Number of bedrooms -2—Number of baths I--- Lot size ------------------------ - <br /> Wafer Supply: Public system [I Community system [] Private Lj----Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam WC- lay Loam [j Clay Ej Adobe L] . Hardpan El <br /> Previous Application Made: (If yes,date----------- ----- --) NoL�ew Construction Yes E] No E3—FHA/VA: Yes4 ❑ No ❑" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ' <br /> otic tank W—cesspool peFrniitfed'if public seAw-­5r— s—available i I a 6e �r <br /> fKin2001eet.]`�� <br /> Septic Ta k: Distance from nearest well_­5 -----Distance from foundation---/Z?--- ------Material_.CVNCA�T_T...... <br /> No. of compartments-----7Z�-----------Size-3 5____.Liq,id cl,p�h____ Z _--.__Capacity._.. �� <br /> 1�r _XC7_4'_� -7/-- <br /> Disposal Field: Distance from nearest well___-54?....Distance from foundation----J p____.__-Distance to nearest lot line------ <br /> u� Number of lines----------/ ___.__..___Length of each line----A?P---/ --- <br /> - -------Width of trench_..._. -ZY---------------------- <br /> Type of filter maferiaL_R_P<�---- Depth of filter Total length--------_-La --------------- -- <br /> Seepage Pit! Distance to nearest well----------------------Distance from foundation-------------------Disfance to nearest lot line_______..__-._.. <br /> ❑ <br /> ine----------------- <br /> ElNumber of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-----.-------------------------- <br /> Cesspool: Distance from nearest well------------ - --Distance from foundation-------------------Lining material-._.____.._._..- <br /> Size: Diameter----------------------- - --------------De th----------------------------------------------------Liquid Capacity- --------------------------gals, -1 <br /> Privy: Distance from -nearest well________-_.__....................._______-_.---Distance from nearest building---------- ----------------------------❑ - <br /> Distanceto nearest lot line-------- -------- ........._------------------ ------------------------------ ------------------------------------------------------- <br /> Remodelingand/or repairing {cicscriber___..--------------------------------------- -------------------------------------------------------------------------------------------- ------------- <br /> ------------------------------------------------------------------------------------------------------------------ ------------------------- <br /> -------------------r----------:-- --------------------------—----­ <br /> ------------------------ -------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- --- - <br /> -------- <br /> ----------------------------------------------------------------------- <br /> -------------------------------------------------------*-------------------------------------------------------------------------- ----- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regu tions of the San Joaquin Local Health District. <br /> (Signed)__ 4',i.4 ------ ------------------------------------------ ---------------- -------------------(Owner and/or Contractor) <br /> - -------------------------- -------- ---- -- <br /> By:,­;�-------�_­ - ���---------------------------------------------------------- ----------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), <br /> FOR DEPARTMENT USE ONLY <br /> --- ------------------ <br /> APPLICATION ACCEPTED 13Y---- --------------- T7 ---------------------------------------- DATE------- <br /> -- <br /> - <br /> REVIEWEDBY----_-------------------------------------------1-----------__A----------------------------------------------------------- DATE.-----------------------_------------------------- ------ <br /> BUILDINGPERMIT ISSUED--------------------------- ------------------------------------ ------------------------------------- DATE------------------------------------------------- <br /> Alterations and/or recommendations:_------ --------------- ------------------------------------- ----------------------------------:------ ----- -------- ---------------- <br /> ---------­---- ------------------- ... . <br /> Nsp Y_-------- ----------------------------- ---------------- <br /> ----------------------- 14>1_40- --------- <br /> - --------------------------------------------------------------------------------------------------------------------------------------------------------------- T <br /> --------------------------_­--­------------- ...........I--------------------------- -- -------------------------------------------------------------------------------------------- ----------------- <br /> - - ------ ------- <br /> - ------------------ ----------------------------- - ------------------------------ ------------ ----------------------------------------------------------------------------------- - ----------------------------------------- <br /> FINALINSPECTION BY--- -- - ------------ -------------- ------------- ----------- Date__---------------------------- -------------------------------------------- - <br /> SAN: JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.R.0 EL <br /> k <br />