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FOR OFFICE USE: L <br /> 6 <br /> 1412- _�:-..-- _.._ � __ _ ___..... APPLICATION'=FOR SANITATION PERMIT Permit No. .f�. <br /> (Complete-in Duplicate) <br /> __ . ._ .------- ._.. This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. S49. <br /> JOB ADDRESS AND LOCATION------ --::5734 X _P - <br /> . - ---E- - '' /------------------------------------------------------------- - ----1 <br /> --- <br /> Owner's Name----- -- ---- ---•----- --- --------- - ----- ----- --------------------- -- --------------------- Phone W;01—•--5- /,9 <br /> ------- <br /> - --A-------- ------- -- -------�-`me--�-r-----�------- -----------------------------••-----l--"----•--...._....---•--... <br /> ------ �_151V1 <br /> '_Contractor's Name �Gt/ � Plone.:•7 <br /> Installation <br /> will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer- rt [Motel ❑ Other ❑ <br /> Number of living units: .-1-__ Number of bedrooms _.. Number of baths -__ Lot size ----- -. ---------------------_- <br /> r <br /> I Water Supply: Public system ❑ Community system ❑ rPrivate ❑ Depth to Water Table, A9 ft <br /> Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2""Hardpan ❑ <br /> Previous Application Made: (If yes,date-.................. ) No New Construction: Yes R--'N- ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F <br /> ..Septic Tank: Distance from nearest well 04--,.�-Distance from foundation.-./Q_------Material ...........----------- <br /> ......._ .-..--.- <br /> t , � Liquid depth....lv.,__-- --.-----Capacit $ <br /> No, of compartments..._-------�.---...size-��S - -- ---• -- _ Y----- - <br /> Disposal Field: Distance from nearest well__/O°' ......Distance from foundation..�_/__4?-..........Distance to nearest lot lines----------- <br /> [i Number of lines -----/--...___ 'Length of each line...__7W-_...X--------Width of trench--... ..................._ =r <br /> Type of filter material's< � .._.sDepth of filter material__,��.._________Total length-__.....7'4..'...................... <br /> Seepage Pit: Distance to nearest well_��-------___-Disfanc04F9T £ounclation__ 5_f..... Dista5e to nearest lot line_-.'. �) <br /> Number of pits---..1-------------Lining material- C?!�_1._.. Size: Diameter.-& -------------Depth------ <br /> -- --- (.�f <br /> Cesspool: Distance from nearest well ________________Distance from foundation-,.__-.......... ..fining materia!-_..............__.-....-.--_._._. <br /> El Size: Diameter - ----- -------------- Depth ---- --------------- _=------------ Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----------------------------------------------.Distance from nearest building-------------------- .-----. <br /> _. ❑ Distance to nearest lot line ---------------------------------- - ------ <br /> Remodeling and/or repairing (describe):..,r! ft� ..... __... - �- �- - , <br /> I <br /> -- •----------------------------------------- •-----•------------- -------------------- <br /> ----------------------- --------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------- <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 tate laws, and rules ;a�n;regulaflons of +he San Joaquin Local Health District. r <br /> Si ned <br /> f [ 9 } = <br /> ------------------------------ - - ----------------- <br /> --------- _._Owner,Owner and/or Contractor) <br /> B <br /> Y ------Title <br /> - ( ( - . . <br /> h (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be pn reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. / / <br /> --- -�-�----�/�'-�--v-�-��'.:4f -- ------------------------- DATE ----��-I�'"C�1�------•-•--------•-- <br /> REVIEWED BY------------ ------------------------ <br /> ------- •-------- DATE <br /> BUILDINGPERMIT ISSUED-------- ------------------------------------------------------ ------------------------------- DATE-- ------------------------------- <br /> Alterati`ns an /or co mend!) _ --- ---- ----------------•---------------- <br /> .�.�--- �f ._ - --- --- - -------- �.. ----------------------- -. .------- --- -- <br /> - <br /> -------------- ------ ------ <br /> - ----- <br /> rr"- ------ -------i------- ---- ----------------------- <br /> FINAL INSPECTION BY:-,--.F ----- - 1_.d- f� ,}- �'-d_. Date..........1' ,'/�---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ma:eltan 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 /> K V <br />