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i FO <br /> - <br /> ...................................___.- ---------------- APPLICATION FOR "SANITATION PERMIT Permit No. .Ccz <br /> t [Com----------------------- -------- --------- --- --- <br /> ple}e•in Duplica}e) <br />[ --- This Permit Expires 1 Year From- Date [sided Date Issued <br /> Application is hereby made to the San Joa uin LoGal Health District for 2�4 w <br /> q � permit to construct and instal the work herein described. <br /> This application is made in compliance .with Count ..Ordinance..No._5.49. SCALO/� <br /> N 303 --- •..� _._r_ . , <br /> JOB ADDRESS AND LOCATIOr�____-I DE <br /> �_ C E-_ _ 4. 1. ...__. FWD-----QF:_:_. 1� Aum <br /> Owner's Name I ----�--•----Kq-�A;�-�_� ---� --------- --------------------- <br /> 1 ---------------------------------- <br /> Address-----�3Q_.---- �Qn <br /> Contractor's Name_. `OVD s�------ i <br /> i I r Phone. <br /> Installation will serve: Residence A artment House Commercial i <br /> I� p ❑ ❑ Trailer Court ❑ Motel•❑ Other ❑ <br /> g ' � -© i !---------- ----------------- <br /> ppy: y ❑ Community system- Private De th t W l ; <br /> Water Supply: Public system 3 , , 0 2 titer Table _.__z ft � ` <br /> Number o living units: __ _.___ Number of bedrooms :_ <br /> __ ___ Number. of aths _ -____ Lot size _ _ . ._ 7.� :_ <br /> Y Y ❑r �• p e ? r•: . <br /> Character of soil to a depth of 3 fee} Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe'❑ Hardpan <br /> Previous Application Made: (If yes date_. I,1�No��Ne�Construction: Yes 2--Tgo ❑. FHA%1/A:fYes EJ-'--'No ❑ <br /> YPE-OF.NST.AL••,,,,TION,--AIVDySPECIFICA-T-IONS,,,.. <br /> (No septic }aiik or cesspool permitted if public sewer is available within 200 feet.) € <br /> fi• t <br /> p No: of compartments _. Silstan e from foundation__.,�[l__._____.Material ____f C ._.. 1 <br /> �_ . f <br /> Septic Tan Distance from nearest well_._.b "V <br /> /J <br /> p ze-�-=�IQ-x�--'�'-------Liquid depth--=���------ Capacity.l�.��----- <br /> Disposal Field:.. Distance from n arest well.._.,7r..i�___-_D l '� <br /> 1 � [stance rc�m if'oun�ation___.��_._..__..Distance to nearest lot line____�J___________ <br /> TNumber of lines "_ '` �' <br /> -.._.Len tli o ea// - Width of trench.,.__-:. _ <br /> i � -- 9 C. �ne_- ---- <br /> Type of filter material-_ --- _... epth of filter,.material____._ -__--------Total len <br /> gth___,__..___ ____�1� __ <br /> See a e Distance to well______. istance fyrom?foundation____ _ _ ____.__Distance to nearest lot Ii <br /> p g -- -- � <br /> Number of its___ .. -_ fining ateri3l' ize: Diameter — .Depth- ------7f <br /> A <br /> Cesspool: Distance from nearest well __.___--..__--Distance from foundation---------------- Lining ----- .____.___.._ ` <br /> ----- <br /> ❑ Size: Diarrieter. )r------------- -------- l�a e!pth------------- Liquid- ------ --- ------ -- ._.----- Ca acit ' <br /> • <br /> --=------------------.--gals. <br /> � <br /> Privy:;;� Distance from nearest well________________1!7. __--...____________.__.._._.Disi-ance from nearest building__-_._~"__--_-_--._ <br /> •---------------- <br /> Cl Distance to nearest lot line ------------- = -- - ' <br /> i E Y ---••--------------------- <br /> - 1 <br />'r , <br /> Remodeling and/or repairing (describe]:; .PFs tSUA4 1r ' fry rr 7 (•5 <br /> ------ - Qom_ i <br /> - E Sa��_ <br /> --------- ------- ---------------- ;, = `# '~ 1 <br /> I hereby certify that lehave'Nprepared this application;and that the work will be done in accordance with Sani Joaquin County <br /> ordinances, State laws, an� rules-�and regulations of the Safi Joaquin local Health District. x , <br /> Si ned fir _.. s_. <br /> _ -.[ 9 -cl)_ _ Own rand or_.Contractor ., <br /> --------•-- ----- ---- - <br /> BY `... -----�i-(Title)- _.. � - <br /> (Plot plan, showing size of ot, location o ;system in vela}ion to�wells, buildings, etc., can,be placed on reYerse side). <br /> FOR JDEI?i PlvlENT USE-ONLY <br /> APPLICATION ACCEPTED BY------'-ri -----------r--------- -- - I i <br /> i .. <br /> --------- - --- ------------ - DATE--.-----�--'�-,��-�= <br /> REVIEWED BY -------- ---- - x' . <br /> _ _ DATE:'._..�'"�s__________________3____.__._ , <br /> BUILDING PERMIT ISSUED------ ._©'-�. '�. 6'1 [�'i>t~ <br /> ------------------- -------------------------------------�Yd-UT--DATE--------------'------- i � <br /> Altera}ions and/or recommendations:.-__LF)Ckf- -_.f�.-J./� -___ ALL----( SA-/� ' Q.t_t.------_,_ ---- <br /> M .nif_..._.Q. i s -' r : #r�'..:.:.. t�1J ---------- <br /> --------------------lf+`;.Rb_PA_,- -------- ------ <br /> ----------------- <br /> --------------------- ---------------------•------- - ---- -------------------- --------.---------....__.� �__... <br /> -----------WFur- 7i v►�E �1-ofd-- -/I�c�T-_.!:�_x��r�.[G �4�.__.'�i �_E. ....:FJ.�..._. .---- <br /> F = - - ---- <br /> • I <br /> L : <br /> FINAL INSPECTION BY: Date--------------y`. ©._r: <br /> ---- -----------------•---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Hazelton Ave. 300 Was?Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California <br /> Tracy,California <br /> . E.H.9 2M1.67 Vanguard press '- <br />