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APPLICATION FOR SANITATION PEPermit NoRMIT Date lssued'4__�/, <br /> (Comp in Duplicate) <br /> ct fora permit to construct and install the work herein described. <br /> lion is hereby made to the San Joaquin Local Health Distr; <br /> Applica' e with County Ordinance No. 549. <br /> made in compliance f T`� <br /> C -------------------- <br /> - <br /> This application is e- ;;� ----------I------- <br /> 01 r <br /> ----------r- ----- ---------6-------m--------- --------- <br /> JOB ADDRESS AND LOCAT41?_ -- <br /> ---- -------------- Phone__-_..__.__ ------- <br /> 74- <br /> IA----- <br /> s Name--------------------------------L;Z, ------------------ <br /> Owner' <br /> ---------- ------------- ---- ---- <br /> ------- .. <br /> ---------- Phone--------------- ------------------- <br /> Address-------------------------------------------- -------------- <br /> A -------------------------------------------------------------------------------------------I------ <br /> ❑ <br /> Contractor's Name----------------------------- House 0 commercial [] Trailer Court 0 Motel 0 other <br /> Installation will serve: Residence-4 Apartment /-/-_L t -z F _X1.7q----------------------------------- <br /> I Number of bedrooms --3-. Number of baths ------7- o size <br /> _. Number of living units: /--- tem [] Private M Depth to Water Table ft. <br /> Water Supply. Public system El Community Sys ravel 0 Sandy Loam 23,GClay Loam 0 Clay 0 Adobe 0 Hardpan [3 <br /> Character of soil to;a depth of 3 feet: Sand F1 Construction: Yes <br /> Made. Yes El No §4 New No 0 <br /> Previous Application <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:' <br /> permitted if public sewer is available within 200 feet.) --------------- <br /> /0Material__-____._--;--- <br /> (No septic t;nk or cesspool pe --------------- ------- <br /> -----Distance from foundation--.-,- <br /> nearest h acity- <br /> Tank: Distance from ---Uquid dep� ......— ------- -------Capaci <br /> Septic — <br /> size--- <br /> No. of compartments__-__-- ---- 1, nearest lot line_----------- <br /> '�9( -Distance from foundafion- __/'`--------Distance to nei Ify <br /> V D;sposal Field: Distance from nearest �vell-------------- 6o...........width of french---------"a- -------------- <br /> f each line---------- h <br /> Number of lines------- ....... ------ Length 0,-filter material------- Total lengf <br /> Depth of i . -1 — .. <br /> Type of filter maiferial---d----------------;-,:- Distance to nearest lot line_-------------- <br /> n --------------- <br /> est well=------------L-- -----Distance from fou'dation <br /> Distance to near �4, . L_ - ------------ ---------Depth-- ------ ----------------------- <br /> DisSize. Mameter- <br /> Seepage Pit: Number of pits-------------- ------Lining material----------__ iAl_---------------------------------- <br /> 171 ' foundation....------------------ ---------Lining mater <br /> Distance from nearest well-----------------Distance f I rom . ---Liquid Capacity---------------------- <br /> �_esspool: ----- --------Depth-------------------------------------------------- <br /> Size: Diameter.... ......---------- I building-------------- <br /> Distance <br /> --------------------------- <br /> 0 1 I..-Distance from nearest <br /> from nearest WO I m ------------ <br /> ------Distance to nearest lot line-------- ----------- --------- -------- -------------------------------- <br /> ------------------ ------I-------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------- <br /> ---------------- <br /> ------ --------------------- ----------------------------------------- <br /> i ----------------------------------------- ----------------------------------------------------------------- <br /> -------------------------------------- ------------------------------------------------------------------------------------------- <br /> -------------------- <br /> r ------------------------------------------------------------- -------------------------------I <br /> ------------------------------ . -------- ------------------------------------------------I----------------I---------------- ---------------------_-A------------------ k will be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared this aP lica+ion and that the wor <br /> ordinances, S to laws and rules al)d regulations fan the San.joaquin Local Health District. <br /> ------------------------------_(Owner and/or Contractor) <br /> - -----------Sined �_) itle)-------------------------------------- <br /> i ------------------------------- ----------------IT' — verse side). <br /> BY:-----------------I-------------------------------------------------------------- etc., can be placed on re <br /> n ion to wells. buildings, <br /> (Plot plan. showing size Of lot, location of system i relat' <br /> P <br /> FOR DEPARTMENT USE ONLY <br /> DATE--- ---------5__­1 _)___1;N_.K�;------- <br /> ---- --------------------- DATE <br /> ACCEPTEDBY----------------­___ - - -- -------I- _ DATE__'----------------•--------------------- --------- ------ <br /> ---------- <br /> -�; - -- ------ ---- ----- - DATE----I------------------------------------------------------ <br /> REVIEWED BY--------------------------------------------- -- -- ------ <br /> ---------- ------------- -- -------- -------------------------------------------------------------- ------•'--------------------:---•-------------------------------- <br /> --------------- ---- <br /> BUILDING PERMIT ISSUED <br /> _.:------------------- ------- <br /> Alterations and/or r ommendda�tiioris:---------------------- ------- <br /> �ecom� ------------------------------------------------------------------I------- <br /> ----------------------------------------------------------------------- ------ -I-------------------- -------------I---------- i ---------------......... <br /> --- --------------------------------------------------------------------------------------------------- ----------------------------I------------------------------I------------­----------------- <br /> ------ ------------------------------------ - ----------------------------------- ------------------- ------------------ <br /> --------------------r-------------------- -------------- ---------------------------------- --------------------- <br /> ------------- ...... .................... ... - -_------ ------------------------- -------------------------------------------- ------------------ <br /> ----------------------------------- ------ ------ -------------- <br /> Date--- ------------�Z---------------------- <br /> FINAL INSPECTION 7 <br /> BY:._ --------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> in Sycamore Street 614 North "C" Street <br /> 130 South American Street <br /> Soo West Oak Street Manteca, Califorr0ls Tracy, California <br /> Stockton, California Lodi, California <br /> 145446 ATW130U 17.54 <br />