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FOR OFFICE USE: <br /> -------------------------------------­--------I-------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------- ----------------------- <br /> ------------- ------------- ------------ ------------ (Coirnplete in Duplicate) <br /> Date Issued -- (0 <br /> -- --------- <br /> --------- ------------------------------­­--------- 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 hereinclOscribed <br /> This application is made in compliance with County Ordinance No. 549. r 4J9 <br /> W S) F_= 'n , F <br /> JOB ADDRESS AN15 LOCATIOt?---------------Rt_ap ------- ----------- ------A(---49--------::�.P �CKS <br /> ---------kf�.._TAh <br /> ---------- Phone------------------------------------ <br /> Owner's Name-------_------_-FRoto4-----------C ----------------­---------- ------------------------- <br /> Address-----------------55 ld2............ ------- --------------M..FCA <br /> --------------------------------------------------- <br /> Contractor's Name----- N.F--T;.k------------------------------------------------------------ ---------------------------- ----------- Phone................................... <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel 0 Other ❑ <br /> Number of living units: --.I--_- Number of bedrooms 3---- Number of. baths -/-.-- .Lot size ------------------- <br /> Water Supply: Public system [] Community system [I Private VkKDepth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand Er-G-ravelE] Sandy Loam E] Clay Loam 0 Clay [] Adobe [] Hardpan 0 <br /> Previous Application Made: (If yes,cicite_/A�/------) No 0 New Construction: Yes4ldo Ej FHA/VA: Yes E] No (�— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T <br /> Distance from nearest well--- ----Distance from foundation----/0--------Material--(--D ......... <br /> - Of <br /> No. of compartments------�7------------.--Size--Y..A-10----X:57�Liquid dep�h__ .- ----a—--------Capacity_/Zs4P_Z)--- <br /> Disposal Field: Distance from nearest well.--,"'j, ----Distance from foundation......./0------Distance to nearest lot line_ _.!5_^.. <br /> Number of lines----------3---------------------Length of each line_ Width of trench..-.-. ------------ <br /> Type of filter mate ria 1_30-041-.----Depth of filter material--- Total length---------13<2------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------------_ <br /> Fl Number of pits-_.__________--- ---Lining material------------- ---------Size: Diameter___________________._Depth-_-.._-_____.-..---....._-.-- �' <br /> Cesspool: <br /> epth-------------------------------- <br /> Cesspool: Distance from nearest well----------------Distance from foundation ......_.Lining material_________________._.-.._-------. 0 <br /> 0 Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------.gals. <br /> Privy: Distance from nearest well------------------ ------------------------------Distance from nearest building___________-_...._-..-.-_--.____._._... <br /> ❑ Distance <br /> uilding----------------------------------------- <br /> Distance to nearest lot line_--- -- ---- ---------------------------------------------------------------------------=•--- ----------- --- — <br /> Remodeling <br /> -I-------------------------------- <br /> Remodeling and/or repairing (describe):--' -5------- <br /> ,y_6,7-J!!M...... A -J_N_15m944A��P_--------------- <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> JN_121.E3R-----P PRM--r_-------F)- Bourr---------- -6 -----------�Z <br /> --------------------- <br /> ------------------------------I----------------------------------------------------------------------------------------- ---------------­------------------------------------------- <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, .Joaqu <br /> ,�afe laws, and rules a d regulation off the San in Local Health District. <br /> ............. ----------------------------------------------------------------------------(Owner and/or Contractor) <br /> (Signed) ,/1---- .... . ''rkn, <br /> By:--------------------------------- ---------------- ---------------------------------------------------------(Title)-------------- ----_----------- 00 <br /> ---- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side�j <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY______.. ____- ------------------------------------------------------------ DATE----------3--- --- ---- <br /> REVIEWEDBY----------------------------------------------------- ---------- ------------------ ---------------------------------... DATE------------- -------------------------------- .......... <br /> --------------------- --- -------------------- <br /> BUILDING PERMIT ISSUED-------------------------- T- -- ------------------ DATE---------------- -------- - <br /> Alterations <br /> ATE---------------------------------------------------------- <br /> Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------- ---------------------•---------------- ----------------------- ---------------------------------------------------------------------------------........................ <br /> ----------- ------------------------------------------------_-- --------------------------------------------------------------------- --------------------------------------­------------------------------- -------- <br /> ------------------------------------ -------- --------------------- - ----------------------------------------------------------------------------------------------------------------------- <br /> ---------- <br /> ------------- ----------------------- -------------------- ----- --- ------ - -- -------------------------------------------------------------­­-------------------------------------------- <br /> FINAL INSPECT BY- ---- -----P_ ­ --------- -- Date-------- -- -- ---------- -----­----------------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Mdnteca,California Tracy,California <br />