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FOR OFFICE USE: <br /> i . <br /> ------------------------------------------------------- <br /> -----------I------------------------------------------IM APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------- in Duplicate) <br /> ------------------------------------ (Complete i J <br /> `F <br /> -----------I------ - --------------------- ---------------` - This Permit Expires I Year From' Date Issued Date Issued <br /> Application is hereby made tio"the San Joaquin Local Heal+h-District for a 1�eMt'ffo-construtt.dncl install the work herein.d6"scri"bed <br /> This application is made in compliance with County:O�ainance N 549. <br /> � t,4 1 <br /> • <br /> 11 <br /> JOB ADD WESS AN3 LOC TIO:T� O *AtL_ "Ki> - 6' <br /> ---------------------- -------------------------------- --- -------------------------- ------- - <br /> Owner's Name--------------------- <br /> _.0 <br /> --------- --------------------------------- --- Phone---------- <br /> Addres's-------------- Ii <br /> --------77.�?ofl <br /> ------------------M7 C <br /> ------------------------------------------------------- <br /> Contractor's Name---CP��ftl>--- <br /> ----------------------------_---------:----- Phone---------------------------------- <br /> Installation will serve: Residence PT-Aparfrnent House E] Commercial E] !Trai�er�cCourt El Motel E] Other E]Number of living units: -L---.Number of bedroJm's Number of bath1/,...Lot'size'/0_1-------- X----- <br /> V I I I T 1! 1 - - - 11 <br /> Water Supply: Public system El , Community.system 0 Privaie, Ftr Depth to�W�r Table 23- ft. <br /> Character of soil to'ak <br /> dd-pth of 3 feet: Sand [] 1GraveJ ❑ Sandy Loam a Clay Loam' 0 Clay E] Adobe ❑ Hardpan ❑ <br /> Previous Application Made: [If yes;date .. 'N0 ew Construction:-Yes k4--No E] FHA/VA.: No ❑ <br /> ...... <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No �sd'pfic-.JanVor.c "i 41 permitted if public-.sep'Stanae <br /> is lle200 feet.)L esspoolfromfoundaf-Sepfic-Tan-k- --Distance-from�nearest -----------M aterial VVe?0-P <br /> .-;,Nof olmpartmenfs_-_� -- --------- ----Capacity---49�0_?:;� <br /> -- ----------- -- Size quid dep�h--- <br /> Disposal Field: Di-sf,5ncb 'from nearest well-_.,_.70�._I D' t nV fro daf ion.___ID---------Distance to nearest lot line--- ...... <br /> _a6 line-:----- --I --------- idfh of <br /> N U"M b e r of lines____-i__3 <br /> Le6gf ------Total length-----------------/V r------ <br /> Type of filter rnafe'rial---RJO_o_-KA-D,bj�f'h'o filter material_._j <br /> AL <br /> TM <br /> Seepage Oit: Distance to nearest well------------- <br /> ---!!!Dif—ance r0_M_76u­nd3,f'io'n4k-----------------Distance to,.nearest lot line_________________ <br /> ,jr-C - <br /> El Number of pits----------------------Lining Lining material---0- -------------------Size: Diarneter_-_1__0___­ <br /> .1� I - __!----------------Depth---- --------------I----------- <br /> Cesspool: Distance from nearest well---------------:-Distancleirfrom foundation ------ Lining material------------ <br /> - -- --------- <br /> ------------------------- <br /> El Size: Diameter---------------------------------------De pfl-i-AAki------------------- ---------------Liquid Capacity----------------------------gals. <br /> a sf w�ell❑ --------------------------------T <br /> Privy: <br /> Distance from neare ----- ------------Distance from nearest building--------------------------------------- <br /> Distance to nearest lot line------ <br /> -------------------- --------------------------------------------------------------------------- <br /> ------------------- <br /> A',Remocleling and/ 'fin <br /> or repairing' (describe <br /> --------------7-=----;,_------ --------------------------------------------------------- <br /> ,A-------------- ---------------------------------------------------------------------------- ------------ ------------------ <br /> ----- - <br /> - --------------- ------ ----------------------------------------------------- <br /> r---------- -------w---------------------------_------- ---------------- ------ - ------ 7------------- --------------------------------- <br /> i. . - .. . "I ------------------------------m--------- <br /> i -- <br /> ----------------------------------- ----------- ----- <br /> --------- -------------------- ---- 1 <br /> ----- -- - --r---------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this applicatio ,�add'Tfwaf!fli;�,"W"O"rkiwilI be done�in accordance with San Joaquin County <br /> ordinances," State laws and.rules vd regulations of the San Joaquin Local Health District. <br /> -- ----- - -------------------------- --------------------------------------I <br /> (Signed)------'` ----------------------- -I ------ ------------_(Owner and/or Contractor) <br /> ,A <br /> By:------ ------ --- Jr 4 <br /> ------- ---- ------------- --------------------------------- -- -----I------ ----------------- <br /> ------------------ --------------- ---------------------------- ------------------ <br /> (Plot plank,4swingg'size of lot,;fiocation of system in r,el6f.6n f"well-S,Lbuildings, &c., can be placed on reverse side). <br /> jj� <br /> Fok DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ---------------------I------ -------------------------------------- DATE----- <br /> ----------------- <br /> REVIEWED BY-"--':----------------------- ----------, . I <br /> ------------ ------------------------------------------------- ------------------------- DATE <br /> BUILDING `PERMIT-ISSUED-- --------- � " � __.� � .. L � �_-I— - - ..._..DATE--------------------------- -------------------------------- <br /> ------- -- - ------- ------------------------------------------------ <br /> -------� -0- __4------------------------------------------------------------__ 4 <br /> Alterafions'�and/or reC0rnm9F'jation_s:-_--,- <br /> --------------------------------------------------- <br /> k4 �jr A hll\q�= <br /> ------------------ ---------------------------------------- -------------- ----------------------------------------------------------- <br /> -------------------- <br /> --------------------------------------------------------- ------- .0. <br /> -- ---------:----- - I I .. /'\ --------------­------------------------------------------------------------- ------------------------------------- <br /> ------------------------------ <br /> ---- ---------- --- -iti. <br /> ............ <br /> /---- --------------- <br /> ------------------- - -------------------------------------------------------------------------------------- <br /> ---------------­_­ . .11 <br /> ---------------- ......I... ------ ---------- - ---- ----- --- - -- ------------------------------------------------------------------------- ------------------------------------------ V <br /> FINAL INSPECT -- ----- -- -- ------ Da <br /> te ---------- --------- <br /> --- ------- - ------------ t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .7601 E..Hiiillon Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stock.ton,California Lodi,Cal.ifornia Manteca,California Tracy,California <br /> it <br /> ES 9 REVISED 8-59 3M 2"63 F.P.t:D. <br />