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FOR OFFICE USE:- <br /> I <br /> ----------------%__ t It I <br />------------- -------------------- <br /> APPLICATION TOR SANITATION PERMIT Permit No. ......--.----.-......... <br /> `7, \ __P_ <br /> - - ----------- - <br /> -- <br />--- --------------------A __ --------- (Complete-in Duplicate) Date Issued <br />------------------ ----- --------------- ---------------- This Permit Expires 1 Year From Date Issued e13 <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 made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.... ...... <br /> --------- --- - --- ---- <br /> .7--- - <br /> _ ------AA_ <br /> ----------------------------t" N-VE ,6AC ----- ----- <br /> Owner's Name----------Rho-5, --------jopa*__!�-------------------_--------- ------ --- --__--------IX----------------------------- Phone-.------- -------------------------- <br /> Address......9911.1-0..S.........A_URP!2M_T-----------WA?l.........../W.AJ4J1–C—_C#.j.................. ... ........................................... <br /> Contractor's Name-------go_Ldiq C-1Z,---------------- ----------------------------------- ------- ----------------------­----- ----------------- Phone................................... <br /> Installation will serve: Residence [®]l'Apartment House F] Commercial E] Trailer Court E] Motel [] Other F] <br /> Number of living units: Number of bedrooms .7- Number of baths Lot size -----t4C9en6_F------------------------- <br /> Water Supply: Public system ❑ Community system E] Private UJ-15epth to Water Table IV_ ft <br /> Character of soil to a depth of 3 feet- Sand �] ravel E] Sandy Loam F] Clay Loam [] Clay [-] Adobe E] Hardpan 0 <br /> Previous Application Made: (If yes,date---------- ------- Nok?"&ew Construction: Yes E] No Uj--'fH_A/VA: Yes 0 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 k: Distance from nearest well---S -----Distance from foundation------1C)-------Materia) -- <br /> ----- -- <br /> p No. of compartments-.---Z—-------------Size.$4X1a_Ar_5.__Liquid depth_--. Capacity---/zoo <br /> Disposal eld: Distance from nearest well---..5©._Distance from foundation-----/C)---------Distance to nearest lot line.o .. <br /> .. <br /> p trench--_----- ' t <br /> Number of lines------------If------------- ----Length of each line.. ..... ------...Width of ------------- <br /> Type of filter material....R-OCJ-5-----Depth of filter material-- j-I - Total length------------------- -_--____-__--__---. <br /> Seepage <br /> ength------------------ ------------------- <br /> Seepage Pit: Distance to nearest well__.J00-------Distance from founclation-1.0.......... istance to nearest lot line----S_ <br /> 2T--- Number of pits... .... mate ria 1-1TOCK Size: Diameter--Jt-X-.&-.----Depth-----_10--1- ----------- <br /> Cesspool: Distance-4fo-fin.,nearest well -------------.--Distance from foundation__----------------- _Lining material------------------------------------- <br /> 17-1 Size: Diameter- -- -------------- ------ ---------Depth---------------- ---------------------------------.-Liquid Capacity-----------•-----------_--gals. <br /> Privy: Distance from nearest well--.-._---___-------------__--------------------_-_--- Distance from nearest building--_-------------------------------------- ' <br /> ❑ Distance <br /> uilding-------------- --------------------------- <br /> Distanceto nearest lot line------- ---------- -------- ---------------------------------------_---------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):----------AJGtJ51--V%1`- _-4FXJ.S7 I.IVG �!S -------------------------------------------------- <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 regulations of the San Joaquin Local Health District. <br /> 7(Signed)...... --- -------------­ ­---------- ----------------- ----------------------------------- --------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------- --------------------- --------------------------------------(Title)---------- <br /> -----------------------------(Title)----------I...... -.1----­------------- ---- ------- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, etc., can be placed on reverse side). <br /> FOR DEPART NT USE ONLY <br /> APPLICATION ACCEPTED BY---------'riR.0- ./ ------------------------------------- DATE..--.....9--2!�.7.46,.7------------------- <br /> --------------------------- ... <br /> REVIEWEDBY----------------------------------------- .- -------------- -------- ------------ --------------------------- DATE------ ---------- ----------------------------------- <br /> BUILDING PERMIT ISSUED-------- --------------------------------------------------------------- ---... DATE----------------- ------------------------------------------- <br /> Alterations and/or recommendations--------;----- ------ -------------------- ---------­--- --------------•---------------------•-------------------------------------------------- <br /> ------------------- -------------------------------- ------- ------ ------- --------------- ---------------------- ------------- ---- --------- ---------------------------------.............................. <br /> ------------------------------------------------------------- - --------------------------------- ----------------------------- ------- ......­­--------------------------------- ------------------------------------ <br /> -------------------------- ----------------------------- ----­ ----------- ---- ---- - -------------------- I-------- --------------- ---------------------- ----- ---- -----------------­--­---- <br /> - --------------I--------- -------------------I---- --------- - ........ -------- ­-----I--------------- -----------­­-------- ------- ------------I---- -------------------------- <br /> FINAL INSPE -------- <br /> ---------I........... .......... Date..---- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasolton Ave. 300 West Oak Street 124 Sycomorestroot ;_ql.West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> A <br />