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l`-UK U1­r1Ct USE /-'-//,41 <br /> --------- " <br /> ------------------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No.`--_- <br /> - --------------------- •-- --------- (Complete—in Du- licate <br />" This Permit Expires 1 Year From:Date Issued []ate Issued _1�---_.1�� � <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein des ribed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOC TIO - - --�.�1-�-�---��------ � -`----�� "�""��4 QF---- �-PFJ-1V� �.� <br /> _. <br /> _.. ..---- R.F r�_ _ <br /> Owner's Name ...... - -- - -- -�_'-- --------- ---- -- - ------...--------- -- ---------- Phone------------------------------------ <br /> Address <br /> ------ ----•- - ------------------ <br /> Address-----------------L�...-------------------- <br /> Contractor's <br /> __--L---2--7 <br /> Contractor's Name-- ' -WALF— .....................•--• ------------- ------------ --------- ------- ----- - --------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence{l--Apaetrnent House E] Commercial [jTrailer Court El Mot'e' l ❑ Other ❑ <br /> Number of living units: )----- Number of bedrooms 3--- Number of baths Z Lot size ____. _ - Ic <br /> Water SuPPIY� Publics stem Community s st m ❑ Private <br /> Ra",Depth to Water Table f_57_ ft <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy loam ❑, Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br />""'""""Previous Application Madel(if yes,date ,1'-No New Construction:�Ye�No ❑"yFHA%VA: Ye-s�pNo <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic T k: Distance from nearest weft__ C -.r-Distance from foundtion_..__ . Mat n I ._�0/VC- _-E V% <br /> p <br /> No, of compartments.___..._-___ Sizee}�L�.�' Liquid depfh. �z--- ------C.apacity_.,� <br /> Disposal Field: Distance from nearest weft..... --Distance from foundation__._�0-.____.__.Distance to nearest lot line__......__... <br /> r <br /> Number of lines----------- ::............Length of each line_." <br /> 4..-_.....__.__.Width of trench....___2`F-____°____________._ <br /> Type of filter material__ -0.C,.. `` <br /> 2aC1 . I <br /> See a e' Yp � --Depth of filter material ---.-. --- otal length------------------------------------------ <br /> Seepage' <br /> --------- <br /> p g` Pit: Distance to nearest well--------___-----------Distance from foundation------------.------ Distance to nearest lot line_..__..._____._._ <br /> ❑ Number of pits--- ------------------Lining material-_----------------- Size: Diameter-----------------------Depth-------------------- <br /> ----------- <br /> Cesspool: Distance from. nearest well --------- _-_--_Distance from foundation----------------- ..Lining material <br /> ____________________._.._----------- a <br /> ❑ Size: Diameter- -- ----- --- ----- ----------------Depth_------- ------------------------- --------------Liquid Capacity-------------- -------------gals. <br /> Privy: Distance from nearest well_----------------------------------.---------_---Distance from nearest building __ <br /> ❑ Distance to nearest lot line-------- --------- --- --------------------------------------- <br /> Remodeling <br /> -------------------------------------Remodeling and/or repairing (describe):--- ...... <br /> -------•---------------------------------------------•-- ------------------------j .5Pa5ac.--------- - <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <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, and rules and regulations of the San Joaquin Local Health District. <br /> I <br /> -- _v <br /> (Signed}_'`"""`" - - ........ caner an r-C-ontract --� <br /> . - <br /> -------- --------- -------- ------------------------------(Title)------------------- <br /> _Y_.__. o...... or <br /> t <br /> [Plot plan, showing size of lot,..I tion of system in relation to wells, buildings, etc., can be placed on reverse side]. <br /> FORD ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._.__ i R= ----------- ----------------------- --------------------------------- DATE---=-------. --------------- <br /> fes_' <br /> REVIEWED BY----------------------------------------- - DATE <br /> --------------- # <br /> BUILDING PERMIT ISSUED - <br /> -------------------- DATE. - <br /> ------------------- <br /> Alterations and/or recommendations:--- __..__--___...__...._._ I <br /> ---------•-- - ------------------------------------------------------ -------------------------------- -- ---------------------- ---------•---------- <br /> - -------- ----------------------- -- ------------ ----------------•---- ----- ------------- ------/------ ------------------------------------------------•---- ------------- --------••---------- ---•--- <br /> ------------------------ -------- ------------------------------- ------------- ----------------------------------------------------------------- ---- ---- --- <br /> -------------------------- --------------------------------------- -- ------- - - ------------------ -------'---------------------------------- - ............. i <br /> FINAL INSPECTION $Y:�y� '�� �c.p -0 - 7 t <br /> Date---------- <br /> SAN JOAQUIN LOCAL.HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard press ' <br />