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FOR OFFICE USE: <br /> ---------------------- -------------------------------- <br /> t. <br /> -°` APPLICATION . FOR SANITATION PERMIT Permit No. <br /> ---------------- <br /> --------------- ------------------- <br /> " ------------------•- -------. (Complete in Duplicate) w,: <br /> - - Date Issued ---- -1 _ <br /> ----------------------------------- ----------'>t --. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made 'in `e with County Ordinance .No. 549. <br /> ,, rr _ 4-nT <br /> JOB ADDRESS AND LOCATION. -J-PY ----------- �"® ---AL H �� ` <br /> Owner's Name------------- { ] . -------- ` <br /> ,.Phone -. r <br /> Address. J y ` � ------------------------_----- <br /> Ah <br /> 1 _ -?3 - - 41 �_ <br /> Contractor's <br /> Nameu1lV -= -- Phone <br /> ---------- <br /> Installation will serve: Res-dente Apartment House ❑ Commercial ❑ Trailer Genrt ❑' Motel.-❑ Other ❑ <br /> g Q t� <br /> 1 Lot size __- J-.-_ <br /> Number of livin units: _ -- � <br /> y ❑, CommunttWy <br /> tem f Private Depth to W Table _ __ ft. <br /> Number of bedrooms j---- Number o baths - --_ <br /> Water Supply: Publics stem s r : aterCharacter of soil to a depth of 3 feef: Sad Gravel ❑ Sandy Loam ❑ 'Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous ApplicationMade (If yes�date--- '` _- -_.) No 'New Construction: Yes No ❑ FHA/VA: Yes ❑ No <br /> J <br /> ``��­TYPE'OF-INSTALL'i4TIONtA,NDTSPECIFIGATI - <br /> - &.(No-.septic tank or cesspool permitted if public sewer is-available within-200-feet:) <br /> Septic nk: Distance from nearest well_ ----- Dista ce from foundation---�_� -.Mat riaL-_��� �.��------____-. <br /> No. of(compartments--- d _... -----. _ 7 -_Liquid depth___: .- Capacity----- --.. <br /> e-k - <br /> �- m , <br /> Disposal Field: Distance from nearest well-:-5-0 -Distance:from foundation___--,� -_.--.Distance to nearest lot line--- --. <br /> Number of lines- __--_----1------- -----Length of,each line-----_- ----.-1} Width of trench 2 ". ----- . <br /> f <br /> Type of filter material-_--R-0 C) -.--Depth of,filter materia----- ►------Total length-------------------- ------`--_- .. <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation------------ -----.Distance to nearest lot line ------ <br /> ❑ Number of pits---------------__-Lining material-!_--------------------Size. Diameter--------------------- Depth-------------------------- <br /> .__--- <br /> Cesspool: Distant from nearest well-------------�' Distancefrorim foundation__.--_--Y.-$------ <br /> Lining material--------------------------------------- <br />+: r. <br /> EJSize:`Diameter-. ..- - •------- Depth 1----------------------------------------------- <br /> -••-•- - ----- ------ ---- Liquid Capacity----------------- -- -- -gals. <br /> Privy: 'Distan e_from nearest well -- _-_--- -------- r'. _.--.___-- Distance from nearest building---------------------- ------------------- <br /> JIDistan e. to nearest lot line- --- ---- - ----- --- •-•------- = S. <br /> Remodeling and/or repairing (describe):----------------- ---------------------------------------------------------- t <br /> I <br /> h <br /> I ------------------------' i <br /> ------------- -------------------------------------------------------------------- <br /> - •--•---f <br /> E •---------------------------------------•---------------- ------------ ------------ <br /> I hereby-certify that I;have prepared this pplica ion and,that the work will be done?in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> -- -- ----- ------------_---------.Owner and/or Contractor <br /> (Signed) - <br />:..r�: --�----'"-------""""t''- _"""_•_�-- -----""f_ �---- (Title'`�;.aa.�—. -� ",r ........- - ------- <br /> (Plot plan, showing size of lot, location;of�;ysternain;lelafion fio wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE-ONLY <br /> APPLICATION ACCEPTED BY-----_T --------- :-- ---------------- ----------------------- pDATE------- ------------------- <br />�' REVIEWED BY---------------- -- ----------------- --- � --------------------- ':--------------------- DATE := <br /> r <br /> BUILDING PERMIT.,ISSUED I: -' ------------- <br /> J <br /> Tw lxI`R.e�d, ---,DA7.E - <br /> Alterattona and/or retomri7end ions•----"------------�T-� w ` aX -- = -------------- <br /> ------------------ <br /> _ I. <br /> (� 1.. -------- <br /> - -------- --•--------- . ;Tia •. _ ------ 7�-•. <br /> R�—� ter �P .�: r iD---= ---------- <br /> ---------------- = ' <br /> r r - <br /> ---------------- -------- •------------, ---- ----- <br /> ----- -- --: <br /> t <br /> FINAL IN ECTION <br /> Date------ ---------------------------------- <br /> SAN <br /> --- -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California T Manteca,California Tracy,California <br /> ES 9 RISE. 8-59 3M 3-'63 1.P.C13. <br /> .1 _ A <br />