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FOR OFFICE USE: <br /> ---------------------- ------"`--- --------- ------ Permit No. /A <br /> ------------- ---- ------- APPLICATION FOR.SANITATION PERMIT <br /> ----- ----;--------------------------------------------- (Complete in Duplicate) Date Issued <br /> --- ------------ -------------I-----------------­­---- This Permit Expires I 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.comphance with County Ordinance No. 549. A p <br /> S <br /> l41 L./-" V6 <br /> JOB ADDRESS AND LOCATION- ___f--- -------CR ---------ST5_RTaf�D-----q,------ -------------------------------- <br /> N -4 -------------- Phone------------------------------------ <br /> Owner's Name--------- -------- ---------- <br /> Address--------------- C 1------- � ---------11.(0-6'----------- ------------------------------------------------------------- --------------------:----- <br /> Contractor's Name--_-I&W- ---------------------------- ------------------------------------------------------------------------------------- Phone--------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial Ej Trailer Court [I Motel El Other [_1 <br /> .: 7, <br /> Number of living units: j---- Number of bedrooms _1---- Number of baths __f--___ <br /> Lot size ---- 57 ---------------------- <br /> Wafer Supply. Public system Community systemEl Private E] Depth to Water Table -----V--- ft. <br /> Character of soil to a depth of 3 feet: Sand El' Gravel 0 Sandy Loam [] Clay Loam E] Clay E] Adobe 0 Hardpan E] <br /> Previous Application Made: (If yes,date-----------7------ -) No El---New Construction: Yes E] No ffFHA/VA: Yes El No E�-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or-6eissp'661 pe'ri-nitted if p661i��--seweir iisavailable-within 200-fdi�-t-.)A <br /> Septic Tank: "Distance from nearest wek__C-_V_j---Distance from foundation------ __.Mat r1lar _f?F)"3VV00j_> <br /> ---------------------------- <br /> ,73 ------5<0-C-) <br /> ... ........Capacity <br /> ------------------------ -Size------ iqu <br /> No. of compartments-.Z-.-- 3+ <br /> .7 partmenfs A; <br /> Disposal Field: Distance from nearest well...Cz_W'__Distance from foundation----- Distance to nearest lot <br /> x m Number of lines-------------/---------------------Length of each line--------- 7!...........Width of trench----- -------3-A. ----------- <br /> q-�If�D Type of filter material---R0_C__K-_,,.._Dcpfh of filter material--------11�_,...I----Total length_______________ ---------- - <br /> Seepage Pit: Distance to nearest well-------------- -------Distance from foundation----.______-----_-_Distance to nearest lot line <br /> 0 Number of pits----------------------Lining material--- -------------------Size: Dlamet,er----------------------.Dept h----- -------------- <br /> 1� <br /> Cesspool: Distance from nearest well-----------------Distance from founclation_-----------------Lining material----------------------- ------------- <br /> El Size: Diameter_---------------- ------- -___._.--.-De th _­---------I--------------------------------------Liquid Capacity-.-------------- ...........gals, <br /> Privy: Distance from nearest well............-_!_____----------------------------Distance fr0 7nearest building-------------------------1-7 -- <br /> ------- ------- <br /> ❑ 7 <br /> Dis'fbnce to nearest lot fIre-----------�A----------------- ---------------------------------------I------------------------------------------------- --------------- <br /> 1:Remodeling and/or repairing (describe l---------------------- ------------ -----------------------------------------------I----------------------------------------- ................ <br /> ------------ - --------------------------------1------------------------------------------------ <br /> ------------------------------------------------------- <br /> - <br /> -0. 1 1-------------1 -------------------------------- ------------------- <br /> -------------------------------------- ----------------------------------------------------------------------------------------- <br /> I i ------------------------------------------I--------------------------------------------------------------------- <br /> ------------------------------------ ---------------------------------------------------------III-------------- <br /> .1 1 hereby certify that I have prepared This application and that the work will be done'in accordance with San Joaquin County <br /> :Ordinances, State la and rut s eaulatistos of thd SanxJoa quin.Local.Health,District. <br /> e- -------- -------------------------- <br /> ------ ---------------------------------._(Owner and/or Contractor) <br /> {Signed}-- - ----- --- ------- ---- ----------------- -- <br /> -------------------------------------(Title)--------------- ----- -------------------------- <br /> --- ---- ------------------------------------------------- <br /> (Plot an, showing size of lot, locat"' n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.---.`+- <br /> k--- ---------I- --------------I----------------------------- ---------- ------ - --------------REVIEWED BY------------- ------------------ --------------------------------- ------ ---------------------------------------- DATE--------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations----------------------- - ---------- -------------------------------------------------------------------- --------------- ------------------------------------ <br /> k -th 1-2-A N i i . - <br /> ---•-----------------------•-------------------•-------•-- ----------------------------------------I------------------------------- ---------1--------------------------------------------------------------------------- <br /> ------------------------ - -------------------------------------------- ------------- ----- -------------- ------------------ ---------------------------- ------- ---------------------------------------------------- <br /> - - ---------- ---- ----------------------------------- ---------------------------------- ------------------------- <br /> ___ll�e!22 <br /> ---- ------------------------------------------------ ---------- --- -- ------- <br /> ------------- ------ --------------- - --------------------- - ----------------- <br /> FINAL INSPECTION BY:_., Date.... --- ------------ --------------- <br /> ------------------------------------- ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Str"t 24 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,Ca.lifornia <br />