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APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />Permit No, <br />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. t7LS__5, <br />JOB ADDRESS AND LOCATION__,*_,__1­" <br />wr - V ------ A 1! x/e. ;-------94 4rl, �rx _xx lye ------ <br />Owner's Name ----------"A" --- ------ /------------------- - ---------------------------------------------------------- <br />Phone <br />Address_.�15 k?1W -167 <br />Contractor's Name --------------- 000 <br />- <br />--------------------------------------------------------------- Phone <br />Installation will serve. Residence ❑ Apartment House El Commercial [:] Trailer Court E] Motel Ej OtherA211,44,71 <br />Number of living units: Number of bedrooms ._:?Tr ­Number of baths Lot size _�AKOI <br />Wafer Supply: Public system <br />❑ Community system Ej Private El Depth to Wafer Table ft. <br />Character of soil to a depth of 3 feet: Sand [] Gravel F] Sandy Loam OR Clay Loam E] Clay [1 Adobe F] Hardpan <br />❑ <br />Previous Application Made: Yes E] No gr New Construction: Yes gj.—No E] FHA/VA: Yes [] No 2 __ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br />SepSepti <br />Tank: <br />" k:� Distance from nearest weII__A0T.__"Distance from fcunclation--4,47, Mat ri i ----- <br />?No. of compartments -------- 9 . ..... . .... Size --- KX-SPIK-2--auquid depth ---- •47 --------------- Capac!fy__?dW_11__ <br />_t,p,sal field: Distance from nearest welJ__/9Von <br />_._Distance from four clation-2-A _---_-_-Distance to nearest lot line --- <br />Number of lines__._`_-------------------- Length of each line ---- ---------- Width of french -------- 0 <br />Type of filter material _41ikepth of filter maferiaf ------ /f_��._._Tofal length ------ 4:740 ------------------- I <br />Seepage Pit: 0--,o --------- <br />Distance to nearest well ---------------------- Disfance from foundation -------_----------- Distance to nearest lot line-_____._____.__. <br />❑ Number <br />of pits---------------------- Lining material ----------------------- Size: Diameter-------------- ---.Depth---------------------------- <br />Cesspool: Distance from nearest well ----------------- Distance from foundation ---------------- ining material__.__-____._4� <br />F1 Size: Diameter --- ---------------------------------- Depth ---------------------------- --- ------------------------ <br />----- ------------------ Liquid Capacity Capacity ----------------------------gal <br />Privy: Distance from nearest wO ----------------------------------------------- .-Distance from nearest building ----- -------------------- . 7 <br />El Distance to nearest lot Jine <br />------------------- ------ <br />Remodeling and/or repairing (describe):--------- <br />04� <br />------------------------------------------------------------------------------------------------------------------------------ �w ----------------- ---------------------------------------- <br />-------- / ------------------------------------------- ------------------------- ­____ <br />------------------ I --------------- I ----------------- I --------------------------------- I ---------------------------------------------------------------------- I -------------------------- ------------------------------------- <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, an rules and regu <br />tions of the Sa Joaquin Local Health District. <br />(Signed) ------------------- <br />-� ------------------------------- Contra <br />BY:__------------- - <br />(Plot plan, showing size of lot, lo <br />------ (Tif le) ----- -- - -------------------------- <br />ion of system in relation to wells, buildings, etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY______________________ <br />-- - -- ---------- <br />REVIE------ <br />WED BY ------ --------------------------------------- ----- ----------------------- *----. DATE to _/ -,? - XV Vr ------------- <br />---- - ----- ----------- ----------------------------------------- DATE-- ------- — <br />BUILDING PERMIT ISSUED ----------- -------------- I ----------------------------------------------------------------------- DATE_----------- <br />Alterationsand/or recommendations:_____.____________________ ._ ------------ _ ------------------------------- _ --------------------------------------------- ---------------------------------------------------- <br />----------------------- -------------- ----------------- ­ ----------------------------------- ----------------------------------------------------------------------------------------------- ------------------------ <br />-------------------------------------- --- -- --------- <br />46;ioi� -- ---- / ___ ___ - <br />a J� -------------- <br />------------- ---------- - <br />------------------- f--------•----------•-- - <br />-----------------•-------------- ----------------------------- 7_.� ----- -------------------- ------ --- <br />-------- -------------- <br />FINAL INSPECTION BY: <br />:54-41"414 -------------------------- Date ---- p <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street <br />Stockton, California Lodi, California <br />ES -9-2m I Revise(3 1-57 F.P.CO. <br />132 Sycamore Street $14 North "C" Street <br />Manteca, California Tracy, California <br />