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FUR0FjICE SE: <br /> ........ APPLICATION FOR SANITATION PERMIT Permit No. <br /> T � <br /> ------------------------------------------------------ (C;mplete in Duplica+el- <br /> ---------------------- ---------------11710- <br /> Thii P46nit,Expires I Year Froin Date IssuedDate Issued ........ <br /> Application is hereby made fo­the Sen Jo'aquin.'Local H.eal+h District for a permit to-construct'and install;he work he-rein described. <br /> L <br /> This applicition is made in complian6e with Co Unty Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- :1._/_!__/ ........ -------------------­--­----------- <br /> Owner's Name------,7�_A --------------------- <br /> ---------------------------------•........... Phono................................... <br /> Address t . .. <br /> ......... ............................ <br /> -------------------*-*-*-----------------;......... --------------------- ................ <br /> Contractor's Namo <br /> -- ----------------- -------------------...................----------- --------- ----- <br /> F❑ <br /> --------------------------------------;................ Phone................................... <br /> Installation will serve: <br /> Residence Apartment House <br /> tpaE] <br /> - . . I . -r t-- lm - <br /> I ] 'Trailer Court C] -Motel.El Other 0 <br /> Number of liv!ng'u�ifs: ---_...Number.; of bedroo mis Number of baths _1.... Lot size ------- <br /> Water'Supply: Public system <br /> R__'Colmmurtity system E] Private I-] -Depth fo Water Table -------- ft. <br /> ' 4 1 - .0 , Ii. ' 7 <br /> Character of soil to a depth of 3 feel:' Sand C] 'Gravel E] Sandy Loam El Clay Loam E] 'Clay C] A <br /> clobef] Hardpan ❑ <br /> Previous Application Mader {If yei,date_____._:_____...._.} ew C <br /> No 2__ N_ A - <br /> Construction: Yes ❑..,No.[] FHA/VA. Yes [:] No ❑ <br /> U <br /> T <br /> TYPE OF-INSTALLATION-AND SPECIFICATIONS: <br /> W. <br /> (No septic tank or cesspool pi;rmif4ed if public sewer is available within 200 feet.)' <br /> Sep_fic��nk- <br /> -�Distance from' 'nearest weIP4�..... ista— rom oyndqapon-----!r:.X----------m- <br /> L -------- C~` -------- <br /> �+ompartments-------- ----------Si -- --------------------­---- -----------C ity./................... <br /> 7_" �N o c <br /> Disposak,Field. Distance:-fromr`h6are'st well c______. <br /> rr--r7�i'ta rice M tance to nearest, Iii <br /> fro liounclatio'n--- --J)is' le <br /> Number of lines--t--------- Length of eaA line... Width of trench-----:.. <br /> Num <br /> - f filter-m; <br /> Type 0 Depth of filfeAr,material......../ -__-__----Total length--------PJ.......................... <br /> 4 <br /> Seepage Pit: Distance tonearestwell Diita'nEe_f ro"m Distance to nearest lot line� <br /> umber of pits-----------------------Linimaterial-- k--------- ------- ................. <br /> ❑ N ng Size: Diameter:.......................Depth--------------------------------- <br /> 7 <br /> ce4pool Distance from nearest well..-.-.- - Distanc6 from-foundation.....................Lining material--------------------------------­ <br /> El Size: Diameter--- <br /> -------I----------------------- ...Depth---------------------------:------ ----------------Liquid Capacity-. -------------­-------- <br /> ...gals. <br /> Privy.-. �V Distance fror,nearesf-well__':__':------------------::------- --....'..._..Distance from 'nearest building---------------------­.:1------------------ <br /> F1 Distance to nearest lot-linel"-------------------------------- �A <br /> -- - --------------- --­------------------- ---------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)----------- ---I-­---------------------- ---------------------*------------------- ------------------------------------ <br /> .................................I......................... --------- <br /> -------_----------------- <br /> ------------------ -------I------------------- -------------------­-:................ -------------------------- <br /> -------------------------------------------------------------------._....---._...------------•------------------------------------------------­.................. <br /> ,e � . ­�, : ..................................................... <br /> ---------------------------------------- : I , 0 1 <br /> --------------------I----------------------......._-_____•__-__....._..___------------------------------:--------------------------------­...................... <br /> F k . . , -------------- <br /> I hereby certify that I have prepared this " t <br /> application and;thit'fhe work will be done in accordaince with San Joaquin County <br /> ordinances, fate laws.- and rules andiregulations of the San Joaquin Local Health District. <br /> W-11t----L <br /> (Signed ------ -------------- .... . --Yl----------------------------------------- -------------------------------------------(Owner and/or Contractor) <br /> By:-----------------------------------------------t :H <br /> --------------------­------ ------------------------------ -------- ............------- <br /> {Plot plan, showing size of lot, location-of systein',in relation to wells, buildings, etc., can be placed on reverse side). <br /> `!`FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYA41_._ -r-. ---------------------------------------------------------- DATE---- <br /> R ---------- ------- --- ------­ --- <br /> --- ----------------- <br /> EVIEWED BY... .e..**---------------------I-- ------ --------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED. t, G I - <br /> ---------------------- ------------------- ---------I------ --------------- DATE <br /> Alterations-and/or recommenliations:-.11 e-"T ...... --,v <br /> .................... <br /> 1511 V-------- .. .... ......... <br /> --- -------- /21 <br /> - ---------- 71 <br /> ---------- "Z- ---------------7---------- <br /> -------------------- <br /> ------------------------------------------------------------------------------------------------------------------ <br /> H <br /> - <br /> ---------------------------------------------------- <br /> ------------------------------------------------------------------------------------I--­----------------------­------------ ... <br /> -------------------- --------------------- <br /> ------------------------------------- ---------- ----------------- ------------------ - <br /> ---------------------- -----------------------------I—---------------------------- <br /> ------------------------------------------------------ <br /> FINAL -INSPECTION BY:__/A/1,____ ---- ------------------------------------------ Date-------------- <br /> I - I--------------- ------------------------------------------------- <br /> SAN J OAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California I Locil,California Manteca,California Tracy,California <br /> ED 9 REVISE0 S-89 2M 5-61 ALAS <br />