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FOR OFFICE USE,. <br />------------------------------------------ :-APPLICATION FOR SANITATION PERMIT Permit No. <br />-----------------------------------------I------- ------ <br />----------------------------------------------- ----I... (Complete in Duplicate) Date Issued <br /> !-------- I This Permit Expires 1 Year From Date Issued-- <br />------------------------------------------- -A <br /> Application is hereby made to the Son Joaquin Local Health District for ermit to-consfrud'and install the work heteig described. <br /> 7 11-4 <br /> This application is made in compliance with Cou'hfj Ordinance No. 549. /gwo kr <br /> b ----PARrs------ -------- ------------ <br /> ---i--- <br /> JOB ADDRESS AND41LOCATIO wo- ------ rf=.....4_11, <br /> Phone------------------------------------ <br /> Owner's Name------------------- -----------C-2-V ------------------------- --------------------- <br /> Address- --------------------------------------------------------------------------------------- <br /> ........... 7 ------ ---------------------- <br /> ........... ...... <br /> ti <br /> Contractor's ---------------- ------------------------------------------------------------------------- Phone------------------------------------- <br /> ❑ Apartment House Commercial 0 Trailer-Gaunt --,Motel [], Other E] <br /> Installation will serve: Residence <br /> Number-d,f living units: __/... Number of bedrooms Number of baths -------- Lot size -_-__._-----------------------i---_.___-----__-----..---__ <br /> Water <br /> ----------------------------------- ----------------------- <br /> Water Supply: Public system Ej - Community system,,E] Private Rv❑'Depf1ri to Wafer Table <br /> Sand depth of 3 fe6f: , San� --Gravel 0' Sandy.Loam n Clay Loam [I `Clay [] . Adobe C] Hardpan 0 <br /> Character of soil to a y <br /> No <br /> :'_�f y s date -FHA/-VA�-Yes--D— <br /> Previous Application Made: <br /> TYPE OF INSTALLATION AND .SPECIFICATIONS: .. <br /> (No septic tank or cess'pool permitted if Public sewer is available.within 200 feet.) <br /> east '___Distance from founclation-IC----- <br /> ---- Material--- -------- <br /> Septic Tank: Distance 6m' nea es we e <br /> S iquid clep�h_-_ <br /> No7 of compartmerils.......... ------ ize--"/ X__5, L Capaicity-1------------------ <br /> Disposal Field: Distance from nearest well��-------Distance from foundation-_l -----------Distance to nearest lot line---.!------------ <br /> r - t, r / ------------------- <br /> Number of links---- -----.-Leng of <br /> 12__� - each line-----------------------------.Width of french------ <br /> Type of filter maf6riaI__-_j?_Q_C?�.___Depth of filter.material____j1C4__11------Total length---_142-0-------------------------- <br /> --------------------Dis tance to nearest lot line___.___.-.__..' <br /> Seepage Pit: Distance to nearest well----------------------Distan(fe from foundation <br /> 171 Number of pits----------------------Lining material---------- ------------SizeDiameter----------------,: m -----!_Depth--------------------------------- d <br /> Cetspool: <br /> epth--------------------------------- <br /> Ce4obl: Distance from nearest well--------- -------Distance from foundation-_-__._---_-.----- Lining gals. <br /> material--------------__--.-_-.----__.-_._--. <br /> ------ --------------- ----------- <br /> Size: Diameter-------------------------------------Depth-----------------------------I------------- <br /> Liquid Capacity -- <br /> Privy: Distance from-nearest well-------------------------------------------------Distance from nearest building------------------------------❑ ----------- <br /> ------------- -----------------------------------------------------------­---------------------------- <br /> Distance to nearest lot lire�----------------------------------- <br /> Remodeling -and/o'r' repairing (describe):----------------- ---------- ------------------------------------------------------------------ ------------------------------------------------------- <br /> ,w <br /> ------------------------------------------------------- <br /> ------------------------ <br /> -------------------------------- --------------------------------- <br /> ----------------------------------------------------------6-------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------- ---------- <br /> --------------------------------- --------------------- -------------------- - <br /> 1hereby--certify h--a'-f---I---have'__-----prepared--__ ---'----this---a-_p---p`Ii_caf_i_on_---and-that---.......the_e----work will----b-e----done- ----in- accordance-----with' _...San----Joaquin- County <br /> ordinances, PSTe�a and roles and regul ions0 zfh�oSan Joaquin local QH"I' alf1h District. <br /> - ---------- -- - -------------------- ------------::,-,-,,,(Owner and/or Contractor) <br /> By:----------------------------------------------------------------------I - -------------------------------------------------(Title)---------------- ---- - ------------------ ------------ <br /> (Plot plan, showing-size of lot, location of system in relatirbnf�o wells, buildings, etc., can be placed an reverse side). <br /> Z <br /> FOR DEPWTMENT USE ONLY <br /> tle -- <br /> - -- - --------------- <br /> APPLICATION ACCEPTED BY, --------------------------------- ------------------------------------ DATE- <br /> REVIEWED $Y-------------------------------------------------- -------------------------- ------------- -------------------------- ------ DATE------------------------- --------------------------- .. <br /> BUILDING <br /> ATE------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------ --------------------------------------------------- ----------------------------------- DATE------------------------------ - -_------ -------------- <br /> Alterations and/or recommendations:--------- -------------------- -- ............_--------------------------------------------------------------------_----------------------------------------- <br /> ---------------------------------- --- <br /> -----------------7----- --------------- <br /> --------------------------------------------------------- ------------------------------------------------ -----------------------------------------I---------------------------- <br /> ------------------------------------------------------------- ------------------------I------------------------- ---------------------------------------------------------------------- <br /> - ------------------------------I - ___)-- --------- ------------ -------------------------------------------------------------------- -------------------------•---------- ------------------ --- - ------------- -rF'_ r A <br /> ------ ------------------------ - <br /> ------------------------------------------- ------------------------- ----------- <br /> ­ ---------------------------------------- <br /> FINAL INSPECTION—B- Date........_//7 ---------------------- ------- <br /> SAN <br /> r - ---- --------- <br /> 0- - - - ------------ ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P,00. <br />