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FOR OFFICE USE: <br /> x 8l+ ra <br /> ------- ---- <br /> 51 APPLICATION FOR SANITATION PERMIT Permit No. <br />------ ----------------------------- ----------------- .(Complete in.Duplicate) - — —7—- <br />----------- ---------------------- ­------------ This Permit Expires I I Year From Date Issued Date Issued F----- ------------ <br /> . <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 A D LOCATION--- ---------- -------------------.-------------- <br /> 7 -------- Phone.------------------------------------- <br /> Owner's Name----- ---------------------------- --------------- <br /> !----------------------------- ----------------­----*------------- <br /> Address----------------------------- IZ1-- \JL,) N --- - ---- ------------------------- Phon0�:!�------------_-------------- <br /> --A --- ------ - ----- <br /> Q. <br /> Contractor's Name- -------Zia (�:Z---- ------ ------------------------------------------------------ <br /> Installation will serve: Residence ar ment House E] Commercial E] Trailer Court [] Motel E] Other 0- <br /> psize..____ V V 1, <br /> Number of living units:;_____ -KN,,b,,tof beiroomsc-,-2 Number of baths -/----,Lot ---- -- <br /> j <br /> -------------- <br /> Water Supply: PublicsystemEl Community system [I Private 2---Depth to Water El Clay Table ft.( <br /> E] <br /> Character of soil to a-depth of 3. feet: . Sand Gravel [-] San oanm Clay Loam 0 ay El,7Adobe ET-1Hardpan El <br /> A <br /> Previous Application Made: (If ye's,date----------_7--------) No a� N C,e, nstrucfion. 'Yes No El FHA/VA-. Yes L,,-/No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se Distance from nearest well-0----------Distance fro ---------- <br /> r foundation-/ <br /> P /Liquid dep�h._4.�_�z---------------Capacity--------------------- <br /> Nc�. of compartments-------lrf��-----------Si,e---- - ----- <br /> D;sposaI Fi Id: Distance from nearest well___._...'.Distance'.Distance from foundafion,/-'-7--- Distance to nearest lot line ----------- <br /> Number of lines------QJ_:- ------ ----------Length of,each ---Width of trench-_;;P_---!.._:C"`--_____._ <br /> Type of filter maferiaI---1/2 material__ ---__r_Z_C -bepfh of filter M at e r -- <br /> ------------------------- <br /> See Vag Distance to nearest well_;�_Pa, ______Distance from f6undation--A)---/:----Total length-Am L_Distance to nearest lot line._'-----_--_____ <br /> Number <br /> ine----------------- <br /> Number of pits_Az;��------:------Lining material _ Size: Diamete'r.-22--'o---------Depth___�,S--------------------- <br /> Cesspool: Distance 'from nearest well_________________Distance from foundation...._:'________..Lining material__-.____..____.._________________-_ Q <br /> [] Size: <br /> aterial------------------------------------- <br /> Size: Diameter--------------------------------------Depth--------------------------------------------- ----Liquid Capacity------------ --------,------gals. <br /> Privy: Distance from nearest well_.__._._______________________ ____ -------Disfance-frommearest building__________.__._______________--:--_-__.._. <br /> F1 ----------- <br /> Distance to nearest ]of line -------------- I <br /> 7---------------- ----------------------------------- ------------------------------- ------- ---- ------------------------- <br /> and/or repairing ------------------- -----------------------------------.......... ------- -- -------- --- -- - <br /> -------------------­--------------------------------------------- 7 <br /> d <br /> --------------------------------------I--------------------------------------- ---------------------------------- ------------------------------------------------------------------------------------- <br /> -----------------------------------------------mw---------------------------I---------------------------------- --------------------------- ----------1-1--------------------------------- ------------------------------- <br /> I hereby certify that I have pre ga red this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State and r u I a regulations of the San Joaquin Local Health District. <br /> 4 <br /> 4 <br /> r (Owner and/or Contractor) <br /> t <br /> . ... --------------------------- <br /> -------------- -- - ----- -- ---------------- --- ---- -- <br /> (Signed)----------A -------------------- ----- ----------- <br /> ioc i &-- <br /> By:-------------------------- --------- - ------ -- ----- ------------:-- - --------- <br /> (Plot plan, showing si o ot.,loca-tion of system in rel,En to wells, buildings, efc., can.be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By__AV--------- a-Y ---------------------- DATE....... -------- <br /> ------------------------ <br /> ------- ----------------------­-------------- ------/-------------------------------------------------- <br /> REVIEWED BY-----_---------------- -------------------------- ------- DATE <br /> - <br /> BUILDING PERMIT ISSUED---------------------- ---- ------------------------ DATE--------------------------------------C,------------ <br /> ------------------------------------ <br /> Alterations and/or re ommendafions: 2----? P - ---------- <br /> ,!�7 ---------------- -- <br /> ------------------------- ------------ <br /> ---------------- --- - ---- ------------------------------------------ ------- --[7_ r..... ------ ---- ------------------------------------------------------------------------------------------------- <br /> --------------- ------------------------------------------------------------------------------- ------------------ ----------------------------------------------------- ------------­----------------- --------- 7 <br /> ---------------------------------------------------------------------------------------------------- <br /> ------------ ----------------------- ------------------------------------------ ---- -------- ------- - --------------- <br /> t <br /> - -- - ---------------------- ---------- - ----- ------------- -------- ----- - ----- - -- - ------- ---------------------------- ------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:-- ------------------- Date--- ----------------------• -- <br /> 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 AEVISED B-59 3M 3`63 F.RCQ, <br />