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FOR OFFICE USE: <br /> -------------- -- <br /> __............................___---- APPLICATION FOR SANITATION PERMIT Permit No. .................... <br /> ---------- ---------------------------------------------- <br /> (Complete;b,.Duplicate) <br /> ----------- <br /> - ----------- Date Issued <br /> ------- ---------- ------------- This Permit Expires I Y"irtirorn 15at. 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND .LIJATION.-t------------MAI ......S."I'�-------N�------------------------------------------------------------------ <br /> Owne�r's ------------ <br /> Name.__------------ <br /> ----------- <br /> -— - - <br /> -------------------- -------------- <br /> Phone------------- -- <br /> Address­---------------- V <br /> \7------------------1.-�-------------------------------*------------------- -------- <br /> - ----------—PF6n' <br /> -------------------------------------------------------- <br /> Contractor's—Nbrfie... <br /> JX ------ . . ...... <br /> Installation will serve: Residence! <br /> esidence ge-�Aparfment House Commercial E] Trailer Court El Mofel,E] Other F <br /> Number of living units, <br /> (---- Number of bedrooms Number of baths _..f-- Lot size ------- <br /> Water Supply: Public:system iK­Q'-ommunity system 0 Private E] Depth to Water Table ---- ft. <br /> jr I i — <br /> Character of soil to of 3 feet: Sand,E] Sandy Loam E] Clay Loam' [:] Clay [] 'Adobe ­H <br /> ar�lpan El <br /> e a t e it kc'061 No R'--FHA/VA: Yes D No <br /> Previous Application Made: (If 11 K) No <br /> E]j, New Construction; Yes E] <br /> TYPE OF INSTALLATION' AND SPECIFICATIONS: -r <br /> .(No septic tank <br /> or cesspool permitted if public sewer_js-available within 200 feet <br /> Septic Tank: 'Distance from <br /> nearest well.................Distance from foundation_.__-_-----_.-­ ---Material--------- <br /> Y - ----- <br /> ------ ------------------------ <br /> 1K IFXI;f 5 No. of!compartmenfs----- -------------------Size .Li uid cleoh------------- -- ----------------------- <br /> ....................Distancenearest ptline"".-..-._._...... <br /> Disposal Field: 'Distance from neares�-well-*--------------Distance from foundationto <br /> iNumbe'r of --------Lengih of each line------2-6-* --Wilfh of �rencq---- <br /> ----------- --------- --------------------- <br /> Type of filter ffia IaI3V­*QCX-'D.�Dth of filter material---&U---- ----1 Total length-­ ' <br /> _as I------------------- <br /> Seepage Pit* Distance to nearest well ' ---Distance <br /> I j t . I I <br /> ------------Di,iQe f f on -4--144 i!� <br /> from fou anon Disfande to - ..-M <br /> jware§f lot line ------------- <br /> i A ­v W 14&J-JC dn <br /> Number of pits_;__...Lining material.__: size: Diamete <br /> Ce A .fromr to ----- ------------ 1aR <br /> it k ----------- 'foundafion-------------------Lining material.!Distance from nearest well <br /> ------------------------ --* <br /> ❑ -Sizi;� Diameter------ <br /> ----------------- -.--L;qu.id Capacity----------------------------- <br /> lk 7 gals <br /> Privy, Distance'-f, k I - I I <br /> rom nea' ......p--t7:;--------------r�, ------ ---Distance from.nearesf bui�cl�ng----6.1 6---------------I---------- -------- <br /> - 1 �f-�,i"�,z, <br /> ❑ Distance to nearest lot line-'...- —.1 <br /> -------------------------------------- --------I---------------------i----------------------------------- <br /> Remode repairing (de <br /> ---- -------------- <br /> ling and/or crib -----/rye------7­ ' 0 le.ke <br /> - ------------------ <br /> ---------------------•-•-------• -------------- ------- - ------ - A ------5-' <br /> ------•-----------------{---1 1 y S f ----------------------I------------------------------------ <br /> - ------------------------------------------------ ------------------------------------------------------------------I[—------ ----------------­- <br /> II I------------------------------------------ -----------------------------f----------------------------------- <br /> --------- -------------- -------- -- --------- --------------------------------------------------------------------- - - <br /> I hereby certify that I have pre��ared this`ap�lication and that ihe�w`ork will be done-in accordance with--San---------Joaquin--County <br /> . - . - <br /> ordinances, State laws, and rules an� regulations a e San Joa,�Wp LocM Health District. <br /> (Signed) <br /> ....... ---- --- ------------------------------------------------------ nfractorl 7 <br /> ----(Owner and/or Co' <br /> By--------- ----1- 6 1 ,I <br /> ------------------------------------------------- ----------------------------------------------------------------(Tifle)---------------------------------------- .......... <br /> (Plot plan. showing size of lot, location of system in relation to wells, buildingt . <br /> s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYi----------- --------------------------: DATE -- <br /> -C <br /> REVIEWEDBY ­--­------------j------ -------------------------------------- -- ----------- <br /> ----------•------ DATE <br /> BUILDING PERMIT,"ISSUED--------------- --------------------------------------------— D`ATE - <br /> Alterations and/or recommendation <br /> ss----..._;_.__....._ ------------------------------------------------------------------------------------------------ <br /> ---------------- <br /> ... . -- - ------- - -------- <br /> --- ------- -- --------- <br /> oAk --- -------- -- - ----- r I <br /> V---------- <br /> -----------------------------A�.- ------- - ---- ------ <br /> j,-------------- ----------------- ------------------------------------------------------------------------------------ -------------------------------------- <br /> -------------------------- --------------- ----- ------------- <br /> ----------------------------------------- ---------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:-S.�Aw.i --------- Date...... <br /> - ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B.59 3M 3-,r3 <br />