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APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />Permit No. <br />Date Issued ----- ��7* <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 compliant 'fh County 0 <br />rh C <br />Anance Na. 549 <br />ti <br />JOB ADDRESS A <br />LOCATION___. ---- <br />k -------------------------------------- ---------------------- - <br />--------- <br />Owner's,Name ------ a -&-u-, . .......... . <br />- ---------- ------------- <br />------ - ----------------- Phone - <br />Address --------------------- <br />-7 ---------- ------ -------- -------------------------- <br />Confractor's' Nali�,_! ------- Phone_",,e/a <br />----------------­---- --- -Installation will serve: Residence l parfment House E3 Commprcial ❑ <br />Trailer Court [] Motel 13. Other El <br />Number'of liying units: Number of bedrooms -3. - a N-fu'rn'teo r of baths :Z� Lot size ------- <br />Water Supply: Pullic system ommunity system E] Private E—ffepth to Water Table <br />Character of soil to a depth of 3 feet-TSand E] Gravel Ej Sandy Loam E] _Qay Loam 0 Clay ❑ Adobe [3'_Hardpan E] <br />Previous Application Made: Yes No ❑ New I Construction: Yes i FHA/VA:.. Yes E] No E] <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or'cesspool permitted if publi sewer is available within 200 feet.) <br />4' <br />---------- --- ---------- <br />Distance from 'nearest well___ RZ01--'Dis+ance from foundation --- 14? -------- K4aterial ---- 0_�E _­ -------------- <br />No. of compartments -2e ------------- depjh --- %T_t? " ----------- Capacity ------- fp �- (Z.L, <br />Disposal Field: Distance from nearest well_.. I `D's6n 6f3'i foundaf ion, <br />---------- � I ce from ------------------- Distance to nearest -lot line ----- <br />Number of lines ------ ------- Length of each line --- of french ....... -9c "/ <br />------------------ <br />Type of filter mafriaJ_'%L- L1_N_1._:_Depfh of filter material ---- -------- Total length ------ --- /_R I <br />------------------------ <br />-),-5eepqg�eif:,S Distance 4r <br />------ Distanje from founclafion-1-0 1_0_________.Distance f2 nearest lot I; <br />Number of p;fs,---, - ------------ Lining material-----" <br />ER -- ------- S___ -Size: Diameter -------------- <br />Cesspool: Distance from nearest weli -------------- _Distance from 'foundat ion --------------------- Lining'maferial ---------- - k <br />El Size: Diameter__--___-------------------------------Depth-------------------------------------------- C� <br />I - ---------- ----------------_-------Liquid Capacity ----------------------------gals. <br />Privy: Distance fromJ - <br />Disance 11� <br />nearest weJI ------------------------------ ------------------ Distance from nearest building ------------------------------------------ <br />"Distance to nearest lot line________'_________________i <br />f -- ----------------------------------------------------- <br />r--------- --- ----------- -------------------------- <br />rA <br />Remcdeling and/or .repairing ides i ------- <br />---- - --- - ------ -- <br />. . .. ....... . &/V_1 — ------ Y_ <br />------------ --------- <br />--- j - --------------------- <br />.02 1 . --------- Z_ _� - ---------- <br />---- - ------------ ---------- - ----- 77!TT�!- ------- <br />---------- - - - ------------ ---------------------------------------------- ----------- <br />- ----------------- <br />re <br />aye prepared this application and that the work will be done in accordance with San Joaquin County <br />-v <br />a <br />f <br />ordinances. State ka�',,w,_ �.nules and. regula ns of th an J ealt isfrict. <br />(Signed) - ----- ----- 0ZM9Z0Tl1*tw Contractor) <br />------ <br />-------- zt ---------------------- <br />By:_ -------- �1 <br />----------- ---------------- -------------- --- - - - -- - - ---- ------ <br />- ------- /ef ----------- (Title) ---------------------------------------------------------------- <br />(Plot plan, showing, -Size of lot, location of system in rela n o -we Is--,' buildings, c., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION'ACCEPTED <br />B-----------------B-Y -------- 4-� DATE <br />--------------- ---- - ----_0rI--- _-_-_-_-4 -- <br />, -------`-- ------------------ <br />-�-------------- <br />REVIEWED BY ----------- -------------- -------------- DATE--- ------- ----------------------------UILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE --------- <br />--- <br />Alterations and/or recommendations: -------------------- <br />L <br />---------------------- -------------- ------- ------ 4 ------------------ ---------------------- ------------------------ <br />----- --- ----- <br />- <br />--- <br />----------- - 191-11 -------- <br />------------------- ---------------------- ------ <br />------------ <br />------------- .... - t ------ -------- <br />---- - ------- ---------------------------------------------------------- 64 ----------------------------------------- -- ---- - <br />------------- ----------------------- I -- -------------- - <br />----------------- -------------- ----- I --- --- -- --------- - <br />------ -- - - -- --------- --- - ---------- ---------- --------- I ------ -------- -- ---- <br />--- FINAL I NS P E C ON 8 <br />-- -- ------ ---- --- ---- Date-- `r� <br />SAN <br />ate--- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES -9-2 M Revises 1-57 FRCO. <br />