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FQR OFFICE USE: 'I <br />-- ----'---------------------- ---------------I // p <br /> 'INo. <br /> APPLICATION FOR SANITATION PERMIT Permit <br />"---------------- <br /> ------------------------ -------------------1 (Complete in Duplicate). .,'. <br /> ---------- ------------------'F This Permit Expires 1 Year From 'Date Issued .F Date Issued <br /> Application is hereby made to':fhe San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made irl�ornpliance with County Ordinance No..549. WMA/\f 7--f—i-Cr) <br /> b`�J - - .6 I--!=---�D...... ----- 5 ...- ?-E---F ��} am� •'-----•----- <br /> JOB ADDRESS AND":LO ATE <br /> Owner's Name Cki: _ Q � - '. Phone---"""--•�-----------------•---- <br /> j� x _ -- ..... <br /> i .� <br /> AddressF•�•r - _ 3 --------------- ----------------------- ----------- -------------•-•---.. <br /> ContractorsName------CC�___2_L -D-- -------------------------------------------------------------- ----- --------------------------------------------- Pho_ ne.---....-----------•-•------•-•---- <br /> Installation will serve. Residen�ce",(Tr,. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El' Other ❑ <br /> Number of living units. I-1---- umber of bedrooms ...?_ Number of baths _jl Lot size ----- -._x----- --------------- <br /> Water Supply: Public system;El' (Community stem El Private Depth to Water Table,. :ft. <br /> Character of soil to a depth of 3 fee: Sand ] Gravel ❑ Sandy Loam ❑,wClay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: {If yesdate'° -.--..1`MNo_�New`Construction: ,Yes o ❑ H /VA: Yes No El <br /> TYPE OF INSTALLATION AND SPEC{F[CATION y j <br /> �­(No septic+ank-or cesspool permitted Tlf`pubiic sewer is available within'200 feet.) <br /> .,. <br /> SepticJ54: Distance fr6 i riearest well-_60- 2Distance from foundation_-__- -!/ <br /> � �s� �.11 r <br /> ----------Material--/3-'{-p-��©-� ----------" 1 <br /> No. of compartments-------- -- --Size-�``X-��_x_,�� __Liquiddepth---- -----------Capacity--� .--- <br /> Disposal Field: Distance from nearest well_,.570_....Distance om foundati n-__../-s�' --.Distance to nearest lot li`e--- � - <br /> �/ Number of, lines_---------- - Len th of.eacWine_-7i -. 'bP-Width of trench---_,2-y---..-- <br /> lJ i g * •t 7---------•--- 1 <br /> Type of filter material-_- Al-_ G1�1_.Depth,af,fiiter" matenaL--� _-----"_-__Total length_,_____---/ ------------------- <br /> Seepage Pit: Distance to nearest well_____-------___------Distance from foundationh,_.1------------.Distance to nearest lot line--.-- ---------- <br /> Ej Number of pits-j_.1-------i----Lining material----------------f_-*-Size T iameter----------------.--._-_Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-_.____----------------.--- ---- <br /> Size: Diameter- 1-------.1------------------.---Dept ----- `_��_-F:`z __Liquid Capacity gals. 4 <br /> Disan� e from nea_r`e_'st building 9 <br /> Distance from Barest well _.______--------------------____.._--_-- _ <br /> ❑ Distance to nearest lot lin . --- ------------- <br /> Remodeling and/or repairing'i(descnl?e�:_2--/.0- -�.T-_-------- CO?��----JNFGj�-n�!�"D---�l3oU-'�-----/00------------- <br /> -I, <br /> �3 iV r!N C1,L1_ 'a -1"%� -�-�- ---' • ---- Zo 5 �- W rte'` <br /> --------------- - t t.Vnlr ...... --------`7`c_I3:- ..__.. . ------------ ---- ---------------------- ----- --------- <br /> "" ---- --- ---=---- - - ------------- <br /> ------ - ------------ v �o <br /> I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules an regulations of the San Joaquin Local Health District. <br /> V <br /> (Signed)- - - ---- - ----- -- ---"-- '-------------------------------------------------- {O and/or. <br /> ` --- ----- '�------- "r <br /> " caner a -..� <br /> syr- ------- ------------------------------ ------ ----- - ------------- --------------- ) i <br /> {Plot plaA,, shorting size of lot,(location of.system,in relation to weNs, buildings, etc., can,be.placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLIC_AT E4NrAGCEPTEDx'BY ;I1 -� °"'^ -" ""rbATE - <br /> REVIEWED BY------------- ----------- ------------------ <br /> ----- - -- - DATE------------------------- ---------------------------------- <br /> BUILDING PERMIT ISSUED- J--------------------- ._ ..� n DATE <br /> •----------------------- <br /> Alterations and/or.recommendations:------------= ----------------------------- -- • - <br /> - -- <br /> .,ef11Q`1� = GI`{ 1/�G�S Q 1 --- �4_n�.-------- -Fj --=----------------------- <br /> ------------------ ------ - --------- <br /> 10M 4t11h'� 4*�N"' - ------ --- �---------------------------------------------------------•- <br /> p ------------------------------------- --------------- <br /> -----•---------------------------------- --- ----- -- ------ - ------------- <br /> ------- <br /> - <br /> ` / ------------------ ------------------ ---------- ---- --- --------------- <br /> FINAL INSP> CT10TY: . <br /> Date. � - ------------------- <br /> II SAN JOAQUIN LOCAL HEALTH DISTRICT n <br /> 1601 E.hlazellon Ave. I� 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,CaliForn[a Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 3M 3-'63 F.P.CD. <br />