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FOR OFFICE USE: <br /> A-3-------- <br /> -------------------- ---------- APPLICATION FOR-SANITATION PERMIT Permit No. <br /> --------------------------------- ------------------ -- (Complete in Duplicate) Date issued __e71F__0 <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 herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--------S -4------X--- <br /> Owner's Name----•-----IOU.,Ile�� - --------- ----------------- ---------- --------------------------------- Phon.e_��o----` 3�21 <br /> Address------------------------------- "" <br /> Contractor's Name` <br /> ddress-------------------------------Confractor'sINa-me-6---------- <br /> Phone..--------------------------------- <br /> --------------------------------------------------------- ------------------------------------------------- <br /> Installation will serve: Residl-rce Apartment House ECommercial ❑ETrailer Court ❑EMotel EOther <br /> El <br /> Number of living units: j---- Number of bedrooms Number of baths ----[ Lot size —A 42 �e 7 4 -.d, <br /> - - ►- ------------- <br /> Water Supply: Public system �ommunify system E] Private F1 Depth to Wafer Table -------- ft. <br /> Character of soil to a depth-of 3 feet: Sand [-] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe[R`arclpan F] <br /> Previous Application Made: (If yes,,date...........7�--------) No pr, New Construction.�y6s ❑ 'No [-] FHA/VA: Yes El No ❑ <br /> 4t-T. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> SeptiIDistance from' foundation__.________-_--_-- Materlai------ ------------------------------------------- <br /> c-Ta n k- Distance from nearest well--------------,-- <br /> No. of compartments------------------------i Size--------------------------------Liquid depth------ -------- - <br /> - ---------Capacity----------------------- <br /> I Distance from foundation Distance to nearest lot line--- 77 <br /> Distance from nearest well A01 <br /> ------------- I -ength of each line------- <br /> Number of lines------------ ... _Ltrench------- --�24� - -f------'Widfh of <br /> -7 <br /> Type of filter material ��_ epfh of filter material 1jr.........Total length--------------- <br /> Seepage Pit: Distance to nearest well----__- --- _I__Distan(fe-from foundation-------------------Distance to nearest lot line------------------ <br /> ElNumber of pits----------------------I Lin"ingimaterial-----=----------------Size: Diameter-----------------_---Depf h------------------------Al <br /> P 'IF <br /> Cesspool- Distance from nearest well---- Distance from foundation--_----------------Lining material---------------- ----------- <br /> 171 fir <br /> Size: Diameter______________________ p t h------------------------------- - ----------------Liquid Capacity---------------------------gals. V) <br /> Privy.- Distance from nearest well------ -------------------------- --t - ------Distance-from.nearest building.-______-___--__-__-_____________..._____. <br /> I ---------- <br /> El Distance to nearest lot line----- --------------- - ------------------ ------------------------ •------------------------------------------ <br /> Remodeling and/or repairing (describe):----- <br /> --------------- ----------------------------------- -------- ------ -------- - <br /> .................I.........­-------------------------------------------- 0- d - --------- -----V: ---------&0-1--------------------- __­ ------------ <br /> -----------------------------------------------------------------------------------------------------------------------------------------I ----------------------- <br /> --------------------------------------------- --------------------------------------- ------------------------ <br /> I <br /> --------------I----------------------------------------------------7-------------------------------------- ------------------- - <br /> I hereby certify that I have prepared this apolication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations 6f'the San Joaquin Local Health District. <br /> (Signed)-----4�1_ -- --- --------------------------------------------------------------------------------.(Owner and/or Contractor) <br /> By:----------------------------------------------------------------------- ----------------------------------------------------------(Title)----,-, <br /> AIL-- -------- r­r .. - ­­------ <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 /> REVIEWED BY------------------------------------------------------------------- --------------- ---------I - Po--- -- --- DATE------------------­-----------A, PPLICATION ACCEPTED By... -------- _-Zce --------------I--------A--V--t........e DAT -------- ir / A ------- --------- <br /> ---------------------- <br /> BUILDING <br /> - -----------------BUILDING PERMIT ISSUED------------------------------------------------------------- -----------------------`-1-------- <br /> Alterations and/or recommendations:._.___.____________________ -- --------- -at t8 I <br /> ---------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------- - ------------------ ------ -------- -------- -A # I <br /> ------------------------------------------------------------------------- <br /> ----------------------------------------------------------------- -- - ------- ------------------------------------ ------------------------I-------------------------- I------------------------------- <br /> ---------------------------------------------------------------------------- ------- ------------------------------------------------------------ -------------It--------------------------- ------------------------------- <br /> - ----------- ------------------------------------------------------------------------------------ ------------------------------------------------------------ ---------------------------------- <br /> G <br /> FINAL INSPECTION BY----------------- -------- ---------------------------------- Dafe........ ------------ ---------3 <br /> ----------------------------------------- <br /> SAN JOAQUIN LOCAL 0EALTH DISTRIC <br /> 60, b% I <br /> 1601 E.Hazelton Ave. 300 West Oak Street y 124 Sycamore Street 205 West 9th Street <br /> Stockton,Callfornio Lodi,California Manteca,California Tracy,California <br /> CS 9 REVISED S.59 3M 3"63 F.P.CO. <br />