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FOR OFFICE USE:� <br /> -- -------------------------------- ---- <br /> APPLICATION-FOR-SANITAInON PERMIT Permit No. <br /> ------------- <br /> ......------------------- [Complete-in Duplicate) <br /> 4 - - ------------ <br /> .................... ........ This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor,_hqrein described. <br /> This application is made in compliance with County Ordinance No. 549. 0�o 9 AC` fgff!Ejj:. <br /> iv <br /> IVY <br /> or—7-7 13usHkoq <br /> JOBADDRESS AND LOCATION- --- ---------- ------------- ---------------------------------------- ----------- - -- ----7-4 ------------------------------------------ <br /> k7. "' t-Aft -SA <br /> Owner's Name--------------- -------44:Z'-w <br /> .j_ -1 Phbne--------------------------- -------- <br /> . - 7 - --- - -------------- TAddress -----•---------------------_----••-•---•------------ <br /> I <br /> Contractor's ----_--------------- -------------11,------------ -------- ------- ­----------------------------­------ Phone--------------------...------------lor� <br /> Installation will serve: Residenceg5 Apartment House l[] Commercial [] Trailer Court 0 Motel [j, Other L] <br /> Number of living units: J----- Number of bedrooms - ------ Number of baths-------- Lot size <br /> I ------------------------- <br /> Water Supply: Public system [:] Community sys_f�EB_m­-E]--Pri'vafe ®depth to Wafer Table <br /> Character of soil to a depth of 3 feet- Sand ffGravel,o Sandy Loam D Clay Loam El Clay ❑ Adobe U Hardpan <br /> Previous Application Made: (If yes,date................... I No K]`<ew Construction: Yes 2---N, ❑ FHA/VA: Yes ®�No ❑ <br /> -TYPE OF INSTALLATION:AND SPECIFICATJONS.- <br /> (No septic tank or` cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well....4*_0---Distance from foundation--- eria;------ ----- - <br /> Se t' T 0 APC RJE7 <br /> ---------- <br /> p ic 10: .... M,f TiF.71 <br /> wll� No. of comparfments____._,_,_'_3...........Size------------------------------Liquid dep.th..... -------- Capacify_�99V------- - - - <br /> Disposal Field: Distance from nearest well....-15-0___._Distance from foundation..../0..........Di5fance to nearest lot line_; <br /> of lines._____-_2—-------------------Length of each line-------/00- _" �Width of trench.___-Z�Y_ ------------- <br /> T 1 .q__.........T,tai length--- -----..e_1 6�?---------- <br /> ype of filter material--ri-0.05�_ _:Depth of filter material_-__.__ <br /> Seepage Pit: Distance to nearest well------------ ---------Distance from foundation--------------------Distance to nearest lot"line----------------- <br /> Al <br /> ElNumber of pits--------------- .......Llnipq material-- --------Size: Diameter--------_ -----.Depth---------"---------------------- <br /> Cesspool; D sfa nce <br /> fromirearest well ----------------Distance from foundation................. ..Lining material....-_------._ -❑ --- <br /> I <br /> S�ze:PDiamefer� - ------------ ----- - Liquid Capacity-----------------------------gals. <br /> Privy. Distafice from nearest well....................:_._..-....----_..._.-..__.-Distance from nearest building.------- --------- <br /> ------------------ - - <br /> Distanceto nearest lot line ------- ----------------------------------r---------------------------------- ---------------------------------------------------- <br /> Remodeling and/or repairing (clescribe):-----___-------R)_U&1>.......14&R_t>_r_-9U1--------47-7------------------ <br /> ---------------------------------- <br /> --------------------------------- -- - ----------------------- --------------11------ <br /> --------------------------------------------- ------------ -- -------------------- ---------------------I------ I -i <br /> ----------------- ---------------I .. ....... <br /> ----------------------- ------ --- --- <br /> ----------------------­ �----------------;------------------ --------------------------------------------------------------------------------------------------- -------------------------------------- <br /> I hereby certify that I have prepared this 6pp1iJafion­a­'nd that the work will beh <br /> �lone in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of'the San Joaquin Dsz Local Health cf. <br /> {Signed)------- 4!! ----- ------ ---- ---------------- ------ -- ----------J-1 -.(OwAer an Contractor) <br /> t. % <br /> y------------------------------------ -------------------------- ---------- --- - --------------------------- -------- ...... .�t--------- -- ---- ----- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildingsi,ttp., can!be placed on reverse side).,.. <br /> 6 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---.. ---i i ----- ---------------------- ------------------------- DATE_---- ------------------------- <br /> REVIEWED BY----- <br /> ----------------------------------- <br /> DATE- <br /> ------------------------------------- -------- <br /> BUILDING PERM IT<ISSU ED:-_�__:= -- -- ------------------ DATE-----------------------------------J------- ---------------- <br /> - -- - --- ---- -------------f-� - -----;--.s------------------------------------ <br /> Alterations and/or recommendations:... ...... ........--------------------------- -------------------------I------------------- -- -------------------------------------- <br /> •------------ <br /> :-:--------—---------- <br /> -----------I---------------------- ----------------------------------- -------1-1-------------------------- -=-----------_-------:------- ---- --------------------------------------:------------------------------------ <br /> ----------------------- --------------------------------------------------------- - --------!�-----------------------------...... <br /> - <br /> ----------------------------------------------- ­ .. - � R-- - <br /> - -------- <br /> ---------- - <br /> - --- <br /> ---------------------------­-----------------------r------------------------------------------- ---- ------------------ ---- ---------------- <br /> -- ------------- <br /> - - -- <br /> FINAL INSPECTI BY:. _ � Date--------- ------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hatellon Ave. 300 West Oak Street 124 Sycamore Street <br /> 20.5 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard'P;.. -Ml <br />