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�— ,FOR OFFICE.USE: A <br />----- --------------- --------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ��eq..7 .Z <br /> __.__. {Complete in Iiuplicate} <br />------- "--'----'-- ------'---' ----'- Date Issued j95____9 <br /> _- <br /> ----------------------------- This Permit Expires 1 Year From 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 co pliance with County Ordinance No. 549. <br /> f]A[tft2M-. � <br /> JOB ADDRESS AND LO ON__�_IV�F------RD------- , <br /> Owner's Name------------------ _M_ ��---------------Mop-R-1_5 <br /> Y cop R-1---`�-------------------------------------------------------------- <br /> Address <br /> -------------- phone <br /> Address.---------•--------_R.F]F-^-I-- SOX--------�� ��------- .....57 _741M-----------------•-------------••---•-••------------•-------•-------•---- <br /> Contractor's Name--------d5VJN_F—P1-------------------------------------------------------- ------------------------------------ -------•------- Phone------ ••-•------------•---- <br /> Installation will serve: Residence ©—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _r______ Number of bedrooms 3-- Number of baths :7-- Lot size ___ ''7//V------A_C_R4�S---------------- <br /> .__ ` <br /> Water Supply: Public system F-1Communitysystem El Private ![Depth to Water Table 7_ ft. �J <br /> Character of soil to a depth of 3 feet: Sand G ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date----- -----------..I No New Construction: Yes E?<o ❑ FHA/VA: Yes ?T—No ❑ <br /> TYPE OF INSTALLATION AND,SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic k: 'Distance from nearest well___ _._--Distancg from foundation___JD________.Materi I_-. NCR - _----.----. <br /> No. of eompartments_....__2 -____---Size-_ __aC1' __X- __,___Liquid depth___fWX' r_____..Capacity_____/2-0-0___ ; <br /> - s <br /> �Q_____.__.Distance to nearest lot line_-___ ________ <br /> Disposal field: Distance from nearest well-:-sG7_._.._Distance from �lJdation__ __ . <br /> Number of lines-------���-----------------Length of'ea/h line------: - --'.Width of french------ <br /> Type of filter materia!-AO -------Depth of filter material--- _ -.__...__ length--- <br /> Seepage <br /> g <br /> -----.Total len th-- -----'----��'�------ <br /> See a e Pit. Distance to nearest well---1 0-_ ________Distance from foundation-----Sd_____-Distance to nearest lot line... <br /> p g , <br /> Number of pits------J-------_-----Lining material�c)njcf"F_�r`t=Size: Dia meter _ __'. .. ----------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---------.----------Lining material------------....____.______-.-.______. <br /> ❑ Size: Diameter--------------------------------------Depth------------------------------------------------.---Liquid Capacity----------------------------gals. <br /> � <br /> Privy: Distance from nearest well---------------------------------------- ____._Distance from nearest building------ ---------------------------------- f <br /> ❑ Distance to nearest lot line------ ------------------ ---------- ------------------------- ------------------- <br /> a <br /> .2:_ ©� Pop—/- - ----------5- �..X -1�'Z-----'Y- I-")------------------------- <br /> Remodeling and/or repairing (describe)_____________________,:_______�- <br /> �1�.1-1�_�------i'�r {�� f } 1~ ------ <br /> ---------------------- <br /> ---- lCF'LF_i_ 1 oC.J�_5 <br /> -'� A�1' �------ `r -----�' S � _ f�©G ----------------------�----------' 0� <br /> ------------`- -- --------- -•---------- --------' ' - ' ' <br /> I hereby certify that I have epared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, . ate laws, a rul d regulations oft n Joaquin Lo�al Health District. a <br /> 4 <br /> '(Signed} ��' ' (Owner and/or Contractor) .I <br /> - <br /> _ �_ Title _. <br /> (Piot pla owing size of lot, location of system in relation to wells, building;etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----------T!R--' '------- --------------- ------------- <br /> -------------------«`DATE.----- --j6- <br /> -- <br /> REVIEWEDBY------------- ---- DATE-------'--------------------------------------------------- <br /> IBUILDING PERMIT ISSUED------------/^-_/_1_kk------------------------------- ------------------- ---------------• DATE----------------------------- ------'------------------------ <br /> Alterations and/or recommendations:..... 13 �..----�Oj3irr5-_-__--C�4-� 1�-______- -Sl -----'-1 -------/ ------- -- X_�_'f 12----t�rT <br /> tNR�. K S-AI-p---y€=` ` 1gsl�cj�_ FR 'Rl.r__!_ - «-L _ ?- T= R `----------------------•--------------.. <br /> ---------------------------- - ---------------------------------------------------------------------- <br /> --------- <br /> -- ------------- ------------ ------ ----------------/-------------'----------------------------------------------- ---------------------- <br /> ------------------ ---------------------------------------------- <br /> y� // <br /> FINAL INSPECTION—BY - --- - -- ------Q-`-�-- L Date .`.vC -'--- ^r�!= ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California <br /> "" ' F. Manteca,California Tracy,California <br />