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FOR 03FE USE: <br />- - ------------- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------- -------------------------- -------------------- (Complete in Duplicate)� <br /> Date Issued <br /> This"P 1 Year From'Diie'lls�u_ed_ ,' <br /> --------------------------------------------- T is ermit Expires <br /> Application is hereby made to the San Joaquin Local Health District for � permit 7ten"stryuct and in all the work herein sorbed. <br /> -0 <br /> a if t c <br /> This applicatiori is made in compliance with County Ordinance No. 549. <br /> .......... <br /> - ---------------------------------------------- <br /> C ....... .2.Y ...... --------- - ------------------- <br /> ----------- <br /> JOB ADDRESS AA LOCATI 4_1 <br /> - ------------------------Phone---------- ......................... <br /> ----------------------------------------- ----------------- <br /> Owner's Name------- :5eet--l- <br /> W-lat---- <br /> Acf&ss--­--------------V­1...... -- -- -- -- <br /> - ------ <br /> - ------------------------------------------------------------------ <br /> -7 - - ----- <br /> 1 <br /> Contractor's Name----------------`---------------- --- ---1- •- - ------ - . Phon <br /> ----- --------- .... -------------------------------- )OV, - -- --- <br /> 7 <br /> Installation will serve: Residence Commercial F] <br /> Apartment House.E]. Com Trailer Court.El Motel 0 Other,[] <br /> L f s ze <br /> N <br /> Number of living, units:.:...�g umber of bedrooms Number of baths Y. .'o i, ------ --------------- <br /> Private Depth to Water,, able'6 ft. <br /> Water- Supply: Public system ommunify system'[ <br /> X" IN i <br /> Character of soil to a depth of 3 feet: San-d E] Gravel El Sandy Loam E] Clay Loam El Clay [] Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date------11_7---------) No [j New Construction: Yes E] No ❑ PHA/VA.. Yes E] No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No sepfic. tank r cesspool permitted if public sewer is available �vithin,200 feet:) <br /> *N ep <br /> 0 s_ r I I ' <br /> a n k,,' Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------_----------- <br /> No. of compartments -----------size---------------------------- -•Liquid depth--------------------------Capacity--_------------------ <br /> F a -Distance from founclation-/----------;�--.Distance to nearest lot line_"A?.0..... <br /> Di I Field: Distance from nearest wet *_ '3 <br /> Length of each line--------------- 0_.:-----Width of french:--- y----------- <br /> Number of lines___.____A <br /> 'spos r"e' <br /> Type of Cter materialss-Ae Depth of filter material----- _V_!�__Total length_:______-_____g --------- 1-10---- <br /> 4page-Pit: Distance to nearest well ---------------------:Distance.frorn fo'Unclation................._Distance to nearest lot line__.___________._. <br /> Nu'mber of pits_..___'______________---------------Lining material-------------------------Size: Diameter------------------------Depth-------------------------------- <br /> Cesspo <br /> Cesspo" I Distance from nearest well---------------:,'Distance from foundation-.---------- Lining material---------------------------------- <br /> t .1 <br /> 0- Size: Diameter�-------------------------------------Depth----------------------------------------------------Liquid Capaci f ty-------_-------------------gals <br /> A <br /> Privy-.1 Distance from nearest well-----------------------------------------------.-Distance from nearest building---------------------------•-------------- <br /> 5 i: " '. - T. t — <br /> C] 'Disfanc e to n'eare t.I lot lin e------------------------------------------------------------------------------------------7-------------------------------------------------- <br /> -s-evIIS------ <br /> Rem0e'�i pend �alring (descri <br /> -2- / <br /> �ej---- ----- <br /> f1w <br /> ----------- ---- ------------------------------------... - -------------------------------- <br /> 7 --------------------- <br /> i i <br /> ----------- ----- --------------------- --------------------------------------------------------------------- ----------- 7--------------- --------------------------- <br /> - ' ' <br /> 1:h&e., certify that I have prep6r6d-thisapplicationand that the work wi Il'be-done in'accor.dance with San Joaquin Cou <br /> ordina-rice ,Tttae ]a s, and ru�tjesAnd regulations of theSan Joaquin Local Heal District. <br /> or <br /> (Signed)------------ - - - --- - ----- ----------- ----- --------- ---------- ------ --------------------- ----- --------------------6� r and/or Contractor) <br /> A <br /> . .... ........ <br /> BY:7------------------------------------------------7-- --------- ........................ ----- - ---- <br /> (Plot plan, showing size of lot, location of pst-e7mi in relation to welO, b dings, etc., can be'placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------------- <br /> APPLICATION ACCEPTED BY_.$V__C_ -------- -DATE__. _—_Zk_=4(_/---------- ----------------- <br /> REVIEWEDBY-------------------------------------------- --------------------------------------------------------------------------------- DATE------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------7------------ DATE---------------------------------------- -------------_----- <br /> Alterations and/or recommendations:------ ---------------------------- -----------------I----------------r-------------­1--------------------------------------.................... <br /> ------------------------------ -------------------------------------------------- --------------------------------------------I----------------------------------------------------------------------------------------------- <br /> ------------I-------------------------------------------I------------------------------------------­ ---------------------------------........................................... -------------­.......I---------- <br /> --------------------------------- - --------------------------------------­------ ------------♦------------------------------------------I----------------------­­-------------------------------------------------------- <br /> ----------------------------------------------------I---------------------------------- -------------------------/-------------------- ----------------------------------- --------------------- <br /> FINAL"INSPECTION Date------- -----------------------------­------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH.DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad[,California Manteca,California Tracy,California <br /> EH-9 REV1136O 8.09 F.P=C 2M 5-613 <br />