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FOR OFFICE USE: <br /> --------------------------------------- -------------- <br /> APPLICATION FOR SANITATION PERMIT Permit..No. <br /> ----------------- - --------------- <br /> ._�. ._ ...:... <br /> [Complete in Duplicate) <br /> ,. Date Issued <br /> ------r-------------------- -.._. This Permit Expires 1 Year From Date Issued i 21-67 I on <br /> i Application is-hereby made to the San Joaquin Local Health District for a permit to construct and instal4 the work herein escribe�.�N <br /> This application Is made in com' pli nce with County Ordinance'No. 549. CG��33 <br /> JOB ADDRESS AND LOC M <br /> I - <br /> I Owner's Nam_e-'_1 _ - �-°� ` 11U'�_t3 ---------- ---- ---- ------------------ --- Phone ---- ---••-------_-•- <br /> ----- <br /> - T' __^-_ � 2�:J _L_DlV '---------------------------------------------------------•- -----------------------__.--- <br /> Cyontractor's Nam6A _-l�- AWA%-----..-----�---•--•---- - ----------------------------------- Phone ' <br /> t � <br /> Installation will aye ' Residence ❑NAFartment House ❑ Commercial ❑ Trail r art +Q�Motel ❑ Other r❑ <br /> Number of livingunits:-___ Number of bedrooms _ t size --_ /4 -jiES--'---------•-------- <br /> •- ___ Number of baths Lo <br /> f � t r <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table <br /> Characferof;soil to a depth of 3 feet: Sand 0Gr`avel ❑,„,Sandy.Loam.❑.... -.ay Loam ❑ Clay ❑ Adobe Elr k Hardpan ❑ <br /> Cl__ <br /> ! <br /> Previo6s Application Made: (If yes, No j�<New Construction:'�Yes ja-­Plo ❑ FHA/VA: Yes ❑ No 2�-� <br /> T_Y,PE�OF, INSiALLATIQN�AND.SPECIFICAT30NS:=-:�., . -�- <br /> [No septic tank or.cesspool permitted if public sewer is available within.200 feet.) i I <br /> Septic Tank:- — Distance from nearest well---. _0- -Distance from foundation____��-__.--..Mated L_ A�'eR- T ___-.__. <br /> �13A1'►rX__, ---Liquid 46 11 Capacity- 9,- ®Q ., <br /> No. of-compi�tme ---------- . . <br /> 3 �r . � f iP t #_ ,y �- ...� <br /> S -----Distance to nearest lot line_...___.___.. <br /> Disposal Field: Distance from nearest well .:....�.__ .Distance from foundation---. .. <br /> ®� t ` _-.-Length of each line t �� <br /> Number of lines---•--_.� ---_----__---- g --#i/2Width of trench..._..__. �----------------- <br /> i <br /> Type of filterlmaterial. _OCK-__Depth of filter material_-__-Ig..�.+-- Total length-_---_-_-_'__ ______._._2- },� <br /> Seepage Pit: Distance to nearest well_ ._.__._ Distance f o_m foundation--------------------Distance to nearest lot.line---- --_-- <br /> ❑ 4Number of pits------------- $-----Lining*materiel--�--- ----- ------.Size: Diameter-_----'_--- -----..---Depth.------ -:--------------------- <br /> 1 Cesspool: Distance from nearest',well-----------------Distance from foundation----- _.__._--.-...Lining material <br /> material----- ----_.._____----..-_-..----.- <br /> C - gals. <br /> ir -Size: Diameter---- -------- -------- --------Depth--❑ QQ <br /> t <br /> t F\ L # <br /> Privy: 4 • ,* Distance from nearest well_____ ___________________________T ______..__Distance-from nearest building------___. --- ---_---------_------_._-- <br /> ❑ Lt.a Distance tolriearestdot line.... -------- --------- ----------------------------------------- --------------------------------------------------------- <br /> emoe.tq <br /> I <br /> g and/or repairing ---------- <br /> ------•------------------------------•-------- ---------------- <br /> t i <br /> -_ I' ----------------- <br /> ----------------------------------` t - t - <br /> ` .. `----- # ---------- { <br /> ---------------------------- --------------------- -------------------- - <br /> ,l hereby certify that I have re aredithis a lication and that the work will be done in accordance with San Joaquin County <br /> I ordinances, State laws, and rules and regulations of;the San Joaquin Loca{ Health District. E <br /> [Signed <br /> ---- ---- --- -=- ----- ----- ---- ------- <br /> (OwnerContractor) <br /> 6 . -- --------- ----- -------------- <br /> (Plot <br /> ---- -- <br /> Plot Ian showin slse o •-----------•--.-------- - ._Ti e `�- ---�'- <br /> [ p! w .g. • f.•lot, location of s4t6 in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY.17 <br /> APPLICATION ACCEPTED BY_ : l-R--C�_�-- - DATE------- -b- --- - ---------- <br /> --- ----- <br /> - - -------------- - �- ------------------=---------------- <br /> - <br /> REVIEWEDBY-----------------=------------ - --------------------------------------.#.}DATE -------- . <br /> BUILDINGPERMIT ISSUED----- --------------- ------------------------------ ----------------------= ------ DATE------------------=---------- -------------- --'----:------ <br /> Alterations and/or.recomemendations:---------------------------------- ---------------- ------ :•----•-------------- - t--- ------------------ <br /> i ncl-r �;` k�. _F—D----c �"i1-f c iD.g. - ' <br /> / - <br /> S4TF-� © _ -------------------- , --- ---- ---------- <br /> --------------� . W � Tt <br /> -------Us ----5----- u _C = <br /> -5 <br /> SowN- - � RED 1l�fs.Plc _r.. °dam Qi ' <br /> I�� p co l= ISD -FOI>,� /N P ��►o�I <br /> FINAL INSPECTION BY----- ----- --- - ---- ------ - /DISTRICT <br /> e-:.------------�e' 7774& <br /> G�4 <br /> SAN JOAQUI LOCAL HEAD 4 , <br /> 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> I Stockton,California Lodi,California Manteca,California Tracy,California <br /> [ F.P.C13. ' <br />