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FOR OFFICE USE: <br />-------------------- ----------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ___ _______IV.12 <br /> ------ <br />---------------------------- ------------------------ r (Complete in.Duplicafe) - - - - <br /> Date Issued - A4 --- <br /> This Permit Expires l Year From Date Issued ��,� <br /> Application is her made to the San Joaquin Local Health District for a permit fo construct aZn nstalOh�e�work hereirj,described. <br /> This application is made in comp fiance with County Ordinance No. 549. N .- <br /> JOB ADDR1wS5 AND LO N.S1_D /� ----�1 --- }�� ` i <br /> Owner's Name 'F !t- X ®- /4 = C�A_R�2- ► 1 _DfC �l_ Phone <br /> n <br /> ------ �_T -fnj-------�-�-{-------- r�.� n ------------------------------------- <br /> ----------- <br /> ------------------------ <br /> Address---,... <br /> Contractor's Name = : - c�--•-----------------•---------- - - t --- Phone.. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel 0 Other ❑ <br /> Number.of living units:.______ Number of bedrooms —,Number of baths ____ Lot size ____ -------• -�`� �- <br /> Water Supply- Public'system ❑ Commuriity sy tem ❑ Private ❑ ' Depth to Vater Table <br /> } <br /> Character of soil to a 'depth of 3 feet: ;Sand° Gravel E] Sandy Loam Eq­ Clay a ❑ Clay ❑ Adobe ❑ Hardpan ❑ I <br /> Er <br /> Pre vkous-Application Made: (If yes,date___.__..__..____.-)` No go ❑ FHA/VA: Yes ❑ No <br /> � w <br /> New Construction: Yes <br /> ti A <br /> TYPE OF INSTALLATION,AND�SPECIFICATlONS , . �_. - _.�.. = � �� __ -.�-F� ��. V�j <br /> (No septic tank:or cesspool permitted°if public sewer is available within 200 feet.)-- r . prop <br /> +-.- p r <br /> Septic Tank: Distance from nearest wel!_.___SO.___Disfance from foundation--- .-----_.Material--C'0�CR�TiF-7_,________- <br /> [� No. of compartments-----�_�___ _-_ .. Siza �---X-, ------.--.Liquid depth' --------------- <br /> -Capacity---t: ---------------• <br /> Disposal Wield; Distance from nearest well.SC0.__-:-Distance from foundation--- *"Distance to nearest lot line____ <br /> [ r Number of lines-----`.--- ------ -_--Length of each tline* ;r ------ <br /> -- -�� Width of trench------� __.-S9--- <br /> Type <br /> /-- <br /> Type of filter-material----PV_G -_Depth of filter material _1 __ __._.Total length___ __ — ) - ---.-- <br /> Seepage Pit: Distance to nearest weIIT"_'_`___- .- 'Diatan a from�fo dation________-_-_____-_.Distance to nearest lot line___'.__.------ <br /> 1 <br /> ❑ Number of pits----------------------Lining material--------------- ---...Size: Diameter_.---------------------Depth------------------------------- r <br /> Cesspool: Distance from nearest well________________Qistance from #ounda'tion " - Luring material__ _ __________f_______:______-_. <br /> ❑ Size: Diameter-------------------------------------Dept h_-----------------.•;: ------ � Fiquid Capacity------------• ---- .gals. <br /> __ <br /> Privy: �. Distance.from nearest well_______________`_-_______:__-______--------------Distance from nearesfi building____.___________,-._'--__�_____------.-. <br /> .,��--•--------------l `-- --------------------Lw <br /> ❑ Distance to nearest lot line ' -------------------- ---- <br /> -- <br /> MI. <br /> Remodeling and/or repairing {describe): _ _ �- ---� t -L^ * tu. 171 _ .. <br /> � ' :... 1 <br /> a. - f= :k - - ��npG_�._ 1�1 t��.D1`� ��P.1=.Qy�-�-----,�=----------- <br /> -------------- - _C F-__K----- r !V] �_ G' ►- ------'0`- €R- - _: <br /> -- I <br /> I hereby certify that I have prepared this application <br /> of the San Joaquin the <br /> work <br /> o kHeall beDistt e n acco da ce with San Joaqu' <br /> -----=------- ---- to County <br /> ordinances, State laws, and les and regulations <br /> K ----------------------------------------- Owner and/ortractor) <br /> ------------- <br /> ----------- <br /> (Signed) <br /> --- ----- ---------------- -------- ----- ---- -- ----------------- --------------- <br /> B <br /> - -1-'---'-�..' .;_[Title)-- <br /> Y:---------------------------------- - ------- <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 /> APPLICATION ACCEPTED BY-. �t �(� ---------- --------------- ------------------------------------------- DATE----- <br /> REVIEWEDBY------------------------------------------------------------------- -- --• DATE__._ --------------- <br /> BUILDING PERMIT ISSUED ---- <br /> = = - - -- - --,.___� rw_: .. TE �,. _ - ------ <br /> - - _..,� --- - <br /> -- - - - ----- ---- ---------- <br /> Alterationsand/or recommendations:------- ------------------- --------t--------k- -------_------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------•----------------------------------------------------------------------------•--- <br /> ---------- <br /> FINAL INSPEC BY Y ® Date . ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-S0 3M 3-'63 F.F.Dd• - <br />