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rvK tirrik-r- u6t: <br /> Ile/,;) <br /> ------------- <br /> - -------- --------- ---------- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> .............. <br /> -------------------- ------------------------------------ (Complete in Duplicate} <br /> ------------------ -------------- ------- - -------- This Permit Ex fres I Year From Date 11' Date Issued _//_::7A0 <br /> Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h <br /> This application is made in compliance with County Ordinance No. 549. erein described. <br /> -- -- ----- 7 <br /> JOB ADDRESS AND LOCATION--------- <br /> . . . . ............................ <br /> Owner's Name-------- t2q I------------ <br /> �41&__j--- -- -------------- - -- ------------------- --------------------------- -------- Phone--00,263_ 7#SZZ <br /> Address----•------ a_-&--ome------ <br /> Af ------- --- --- -------------- ------------------------------------ <br /> Contractor's Narne-_--r�,-1 , <br /> k(--- ----- ---- -----Q__ <br /> --- --- ----------"__ ------ Phone----- _4doK=_-?.RW <br /> Installation will serve. Residence Apartment House 0 Commercial El Trailer Court__E] Motel 0 Other <br /> Number of living units: ___-/-_�Nuermner of bedrooms -.1-1qumber of baths _/-_ Lot size <br /> Wafer Supply: Public system muni ' <br /> omm tY System [I Private El Depth to Water Table .Lift. <br /> Character of soil to a depth of 3 fe'f: Sand E] Gravel E] Sandy Loam D Clay Loam El Clay E] <br /> Previous Application Made- Ilf yes,clate.......... ' ­ �A46be Hardpan 0 <br /> - ------) No El New Construction: Yes [_1 No R5,--THA/VA:'YesE1­ No 0 <br /> TYPE,--Q.F INSTALLATION AND SPECIFICATIONS. <br /> i(No septi or cesspool permitted if Public sewer is available within 200 feet.) <br /> tic T - Di tante from n <br /> b,,No Sept, or C <br /> tic T <br /> Di tanc nearest well_________________ isfance fi6i�_'f6undatibn--------------------Material---- <br /> Nof ----------- ---------------- <br /> - 0 ------ Di <br /> No. of compartments --------------- ize---------- --------------------Liquid depth----------------- --------- <br /> Posal ie --------CapacitY----------------------- <br /> )e Distance from nearest well--t4 'n 0-11 <br /> Number <br /> m6, ce <br /> Distance from foundation____ -------DiJa, ' to nearest lot line----- <br /> Number of lines ;7 <br /> Ty' 01 _441-----�O_Length ofteach line----- <br /> Type of filter ma_�er`_ t�c Width of trench- ------- <br /> -------- _5Depth of filter materfal---------/4q1 <br /> j......... <br /> -Total length <br /> Seepage Pit- Distance to nearest well.,------- ----------Distante f- fance to nearest lot line------------ <br /> rom foundation--------------------Dis <br /> El Number of pifs.'_� <br /> - --------------- ---Lining <br /> t material------I----------- -.Size:-Diameter <br /> P Depth' ---------------- <br /> Cesspool: Distance from nearest woll------------------Distance fr6m­ foundation'-'_-_____.._ <br /> ❑ Size: Diameter---- ___:Lining material_____..______..-______._-____------ <br /> r ----- __�D6'pth----------------- ---------------------------------Liquid Capacity-------- <br /> Privy:; -------------------gals. <br /> Dis�ance frorn,&e;res+ well_-. L ------ ----------------------------- ---------. -Distance from nearest building.-------------------------- <br /> ❑ Distance fo:-neare'st loi.lin6'I <br /> ---------------------------------------- ------------------------------------------------- -----------------------------------r <br /> Remodeling and/or repairing (d e)':--------- r <br /> ------------- <br /> ---------------------------------------------- --------- --------------------------- -------- ----- ---------------------------------------------------------------- <br /> - --------------- ---- ----- - --------- -- ----- - -------------I---------- ------------- <br /> ------------------------------------- ------------------------- -----------if_----------- ------------- --- ----- <br /> ---- --- ------- - -- ---- ----- -------- <br /> ------------------------ <br /> - <br /> --------------------------------------------------------------- ----------------------- -- -------------- ---------- <br /> -------------- -------------------------------------------------------------------------- <br /> I hereby certify fhatilhave prepared this application and that the work will be done in accordance wifll�San Joaquin---County <br /> ordinances, State laws, aneirules and'regulaf;ons of the an 9quin Local Health District. <br /> -TANK-- -- ----- <br /> -------Se:FcT1,= <br /> (Sign�d) viiq�, f <br /> aeik"�CE--------------------- - ----------- - ------------------------------------------ <br /> 'By:-2915LMInerAve.j - HO.�6_3"L Contractor) <br /> ------------------------------------;--------------------------------------- ----- -- ----------- ------ (Title)------ --------- ,E. <br /> ----------------------- - -------- --- ------ <br /> (Plot plan, showing size of lot, location of system in r 0 wells. etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-..----•- --7' --- -------------------------------------------------------- DATE------ <br /> REVIEWED BY---------------------------------------- ---------------------------------------- ---------------------- DATE----------- - <br /> --- ----- ----------------- <br /> -------------------- <br /> BUILDING PERM ---------I---------- <br /> IT ISSUED ---------------------------- <br /> ------- ---------- DATE___------ <br /> Alterations and/or recommendations:--.�---'??#----,g- 'k-I— <br /> -- ---------------------------------- <br /> 1i <br /> ----------------------------------- V- ------- --------------- ---------- ----- ------------------------------------- <br /> 17--- --------------------- <br /> ----------------------------------- <br /> -------------------- ---------- ------------------------------------------------------------------------------------------------------------:------------ -------------------------- <br /> -----------------------------------------------------------Y-7---------------------------------------- ------------------------------------------------- -------------------------- ----------------- <br /> ---------------------- ----------- --------- -------- ------------V------ ---------- -------- <br /> 1 11---------------------------------------------------------------------------------------------------------------------------- <br /> ------------ <br /> PINAL INSPECTION BY:... Date---------- <br /> ---I- 4 -------------- -------- ------ --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E,Hazellon Mt. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California <br /> Manteca,California Tracy,California <br /> P.P.C C. <br />