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t FOR OFFICE USE: <br /> . _:�_� _______- APPLICATION 'FOR SANITATION PERMIT Permit No. .s,..;. <br />°---------------------------- ------ •-----------• -- (Complete in Duplicate) <br /> � _-_--/._-------•��� ' <br />- <br /> -------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here scribed. <br /> scribed. <br /> This ap Bcation is made in compliance with County Ordinance No. 549. r � <br /> 12-0 <br /> 7 <br /> JOB ADCSRESS AND LOCATION----___.._L.il.��1.Fj-�......� ------L_-Sr ----C ; � -.---- l F" J�'�....._.j.4 <br /> _. . <br /> Y4-� ��'a .-J..........-:_�?�t: � ------------------------------------------------ Phone I <br /> Owner's Name---------•------ •---- <br /> Address i ± /_ l 1.31)------------- c T~ —--- <br /> 1 <br /> I <br /> Contractor's.Name....... ----------------------------------`-----------"- -u- ----- ------........----....4-rtlPhone---....-------................................... <br /> ' ' ` size _-••-_-� tel ❑ Other ❑ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer"- �M <br /> �r r <br /> Number of living units. .!..... Number of bedrooms __-r_._ NumV' Depth <br /> baths ----�- Lots �_.... 1g- --�#-_-�------------ <br /> Water Supply: Public system ❑ Community system ❑ privates to Water Table .7. ft. <br /> Character of soil to a depth f 3 feet: Sand jtr Gravel ❑ Sandy Loam d Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-.- 1 Nof New`Construction: Yes }o [3FHA/VA: Yes C] N0 <br /> TYPE.OF INSTALLATION AND SPECIFICATIONS: „- 1 "�..f _` <br /> (No septic tank or cesspool blic s wer is- va #eef.)Permitted if ualable within 200 <br /> _-__Distance from foundation__-_.� ...--.Mat ri I_-.- : ' ._..__--._. <br /> Septic nk: Distance from nearest well-_ <br /> No. of compartments--------------------------Si e_ _ ' -- _` -,_..Liquid depth--.-. .---,--capacity_i_ -__-- <br /> . � ter O � ; <br /> Disposal Field: Distance from nearestell_--` :._Distance from foundation..-�-�!-.._..:Distance to nearest lot line..-_ ...._ <br /> Number of lines---------- ---- O-- - Length of each line----____- _.-._ Width of trench-------- -.-.__-_-,-- .-. <br /> Type of filter. material.- --____==r1`1--.Depth of filter material-----__l -1L`- length _____________`___. <br /> Total th__-__---- I <br /> Seepage Pit: Distance <br /> of nearest __Linin material ® from foundation�iameter_--Distance to nearest lot Brie................. <br /> ❑ p 9P <br /> .a - <br /> Cesspool��: Drstance from nearest well-----------------Distance from foundation---------I------T-2Lining material--------------------:-............... <br /> ❑ Size: Diameter. Depth ' -Liquid Capacity--------------�_ r __gals. <br /> Privy: Distance from nearest well-------------------------------------_ --.-----Distance frlmin Barest building-------------_- __. - <br /> ❑ Distance to nearest lot line----- . <br /> 9 / repairing (describe): <br /> Remodelin and or re airin -' 7` -�---------Ali ' ? , .rlll.-!L ... ." A �"'f 1f ,., <br /> .._.. _ �S uki ------ n A"1 r ► °�------ R , <br /> ...... IU• ..# .---� .- .. �.� <br /> j_-`- T•--I------ ..... ......... <br /> elf a1­------------- <br /> MSTa �.` f-4 Pr: ---­ <br /> -----1� ---- <br /> I hereby certify thaf I have prepared this application and that +he work will be done in accordance with San Joaquin'County }r; <br /> ordinances, StatT laws, and rules and regulations-ofhb'San Joaquin Local Health-'DisfrlGf:�._ _ <br /> -------------------- - (Owner and/or Contractor) <br /> (Plot plan, showing size of lot, location of system,in relation to wells, buildings, etc., can be placed on reverse side). i <br /> - V(FOR DEPARTMENT USE ONLY <br /> P,tLICATION ACCEPTED BY----- [ a ham- `--- -----------•---------------------------------------------- DATE----------5 Y.4 ----------------- <br /> REVIEWED BY' �� �� F� _ DATE :. <br /> BUILDING PERMIT ISSUED..._kA1 _..1WV 45104fitA")^I-----tH -s...- DATE--------------------- ' = ------- <br /> Alterations <br /> ----Alterations and/or recommendations:-.6S----AIDROE_. <br /> -•-----•------•----------------------------------------------------------------------------------------------------------------------------------•-•---•--------•------•------------------------------ <br /> t I ' <br /> f, ti 1 e I <br /> "! ----------------------�-''*••-�-•----- ---------------------------• -•---.....------------------------------__...--=..-...-----------------:..._..---= <br /> --------------------------------- ----- �` ' d __-•------------ �1 ----- <br /> FINAL INSPECTION B .-. I /'f Date .-. - _-.. .:fix-------------------------------------------------- <br /> Y - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E9 9 REVISED 9-99 2Mt 9-61 ATLAS <br /> s � - <br />