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FOR OFFICE USE: ------------- <br /> _______________ APPLICATION FOR SANITATION PERMIT Permit No. i_�3.��--- <br /> -------------------------------------------------.......... (Complete.in"Duplicate) bate Issued <br /> ...........................................---------- Issued <br /> This Permit Expires I Year From Date <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta4l the work herein described. <br /> This application is made in compliance with County Ordi ante No. 549. <br /> JOB ADDRESS AND ATION-�-o ---------- r �// <br /> Owner's Name--------------- ----• ------ -- --------- -------------- ----------------- Phone...`7.`_6 '-`D-77 <br /> i <br /> Address------------------------ -- <br /> 'Contractor's' Name_-------- 61L-1--1T-C <br /> *� ..: ---------------------- Phone------ -- ---=--• ----••------- <br /> -• <br /> Installation will serve: Residence Z--;<Pa rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � <br /> Number of living units: __�___ Number of bedroom Number of baths/- Lot size ----- t <br /> Water,Supply: Public system,,. Community system ❑ Private �.--$`epth to Water Table"41 ft— <br /> .. , �-.�:�..-i <br /> Character of'Wljto.a.dppjth•-of 3 feet-_Sand E] I Gravel ❑ Sandy Loam E] Clay Loam [:] Clay ❑ Adobe Hardpan ❑ 1 <br /> Previous Application Madj: (If yes,date-_4�............... ) No ❑ New#Construction: Yes ❑ No-M FHA/VA: Yes ❑ No ❑ <br /> (34 <br /> TYPE OF INSTALLATION" AND SPECIFICATIONS: <br /> cesspool i public sewer is available within 200 feet I <br /> I (Na septic tank or cesspool permitted if <br /> Se tic Tank: Distance)from nearest well_ �..-Distan e from fou tion__- <br /> . r <br /> s_.y� -Material ---------- ------ + ; <br /> o. of eon artments -. A r f ' fO I <br /> p "fir Size- f�� --_Liquid depth_,,.--/ ------ Capacity � <br /> ---. ---------- <br /> NDisxol�, <br /> I Field: � Distanci from rieare t weli_1-.._Distance from foundation4�Q_____._.Distance to nearest lot line___.__ __... <br /> '+7 Number of lines .-. -rj Length of each line___ ' " <br /> /�1---- -�-- ------ ---- line---7J --------------Width of trench ------'�'-'C------ -----------� <br /> ' Type�of filter materia ._.._ -__.-Depth of filter materiaL___1���r____-_Total length______....___ <br /> � <br /> h Distance to nearwell---- fo _ <br /> undation_ _ .., <br /> .._.- Distance to nearest lot line---X_____._ <br /> eepaj�ei Pit: est 69 <br /> Number of pits.__ .-.---------------Lining material--------a ._._. Size: Dlameterr-nz-- - --Depfk-­.-1-S-- �. <br /> r <br /> Cie2pocl: "`�-� Distance from nearest welt ________________Distance from' ounclation----------------- ..Lining material--------- I <br /> ^4 ,Size: Diameter- -- - ------------ ----------------Depth------------`-------------- ----------------------Liquid Capacity_-------------------------gal <br /> Privy: _ "%Distance from nearest well...----.--------------------------------I_____._Distance from nearest building_____-__...__.___________-____._.___.._. <br /> ❑ Distance to nearest lot line -----'.:...................... J--------- <br /> Remodeling and/or repairing (describe)------------ ---- ---- -- - <br /> --- - - ---- - --------------, '----------------------------------------------------- . <br /> --------------------------------------------------------- -------------------- ---------- �j� <br /> i <br /> ------------------------------------------------------------ <br /> -------------------------------- ----------------------------------------------------------------------------------------•-----------•--•------------------------- - ------------------------------------ ........... t <br /> -----------------------:------------ ---------I- ----------------- ----------------------------------------------------------------------------------------------- ­-------------------- <br /> -- <br /> I hereby certify that ye prepared this applicatia and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la , and rule and regulations of the n Joaquin Local Health District. <br /> C <br /> -- ------ --- ----- --- ---- -- - - <br /> (Signed) Owne ractor) <br /> By: . itle)----------------- ---- ......... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> -- - - � - " FOR DEPARTMENT USE ONLY I <br /> APPLICATION ACCEPTED BY.- - -------------------- DATE <br /> REVIEWEDBY------------ ---------- ----------------------------------------------------- ------------------------- DATE----- <br /> BUILDING PERMIT ISSUED---------- -------------- --------------------------------------------- ---- ----------------- DATE-------- <br /> Alterations and/or recommendations: <br /> r.�......_ : , - <br /> ----- � r -------- <br /> 71 <br /> ----------- ----------- <br /> i <br /> l'r <br /> !..- <br /> -- --------- <br /> ------------------------- --- ------------ ------------- <br /> FINAL INSPECTION BY:- Date--- -1✓Z <br /> ,I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT I <br /> . w <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street ~ 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />