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tVK VFYIU: UJt: <br /> - ------------. -- - - r <br /> APPmCATION FOR SANITATION PERMI'IEW Permit No. _l-./ �fl---s•-•f <br /> - - -------------------- ------------------ (Complete in Duplicate) VI-274 <br /> P /. (1 <br /> __..--_--_--------.-----------_....._ Date Issued .--------._ This Permit Expires 1 Year From Date Issued ..lo, <br /> Application is hereby finede 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 ith County Ordinance No. 549. G ftp <br /> JOB ADDRESS AND CATION. . {{.... _.-.-...` ..-.. . .............. <br /> ?�._ . ..... ..........c.- <br /> ,� Owner's Name- - --� 't.�'.e�ne,�.J - ----- - <br /> ----� - Phone.................. - - - <br /> /�� - - <br /> Address tLCt�.. �� . ..r.----------- -- ... . - -----...-----........................... <br /> u T <br /> r Contractor's Name -- --------- -- - . .. ..- ---- -`.......-----------.. Phone...........................--- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ +Motel ❑ Other [I <br /> Number of living units: -- --- Number of bedrooms .,F_ Number f baths .-f.---- Lot size .--sem -_y.._ 9..E e-ct _-----..--.. <br /> Water Supply: Public system C] Community system El Private [j�Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3,feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [IClay 0 Adobe E] Hardpan ❑ <br /> Previous Application Made: (If yes,date-_--- -------------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> — Septic Tank: Distance from nearest well-.. O___-Distan e from foundatiorl--..--.-/_Q-._.Mat rill_-_---------------------e---------_-----_---. <br /> dl No. of compar#ments-.�.---_-------_Size.fr--.9-- -�_ Llquid depth_.-.-y .-----..-_.-_Capacity...�.c 4i/ Ll/ <br /> Vr <br /> Dispos field: Distance from nearest well---e5d-f..Dis#ante from foundation..--f-Q-------.Distance to nearest tot�na�� ---- <br /> Number of lines.--.-- Length of each line-----J--Q/.Q--i.-_-_.Width of trench--�-----,- <br /> Type of filter materia.-�.�T.-Depth of filter material__j7-__--:�--- g C; / <br /> Total len th HG -------------- <br /> Seeps Pit: Distance to nearest well-----�-.LIQ-.�...Distance fr ndation----I O_--._--.Distancelo neares lot ins---- ------ <br /> Number of pits----- material--, VA-.._.Size: Diameter--_ 3...--_Depth---------------------. <br /> Cesspool: Distance from nearest well.................Distance from foundation-----.-----------..Lining material--------__----.-------_---------.- <br /> ❑ - P -- --- -----------------Liquid Capacity.- _.---------------------gals. <br /> Size: Diameter-----------'--------------------De th--"------------------ - - <br /> t16 j <br /> Privy: Distance from nearest well_------------------------------------------...Distance from nearest building.-----_.-------._---_------.--..---_. � <br /> ❑ Distance-to nearest lot line--------------_-------------------------------------------------___----`------'--' ----------------------------------------- <br /> Remodeling <br /> -----------------------------------Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------------------------------------------------------------............. <br /> L -----------------------------------------------------------------•------•-------------------------------------------------------------------------------------------------------------------------------- <br /> -----' ------------------- ------------------------------------------------- ----- ----------------- - ----------------------------------------------------------------- ' <br /> I hereby ceLlaand <br /> ave prepared this application d that the work will be done in accordance with San Joaquin County <br /> ordinances, Statrules and regulations of the a Joaquin Local Health District. ���L - -- - eea <br /> ------' (Vv7rLer Contra <br /> (Signed)--------------- end/or Contractor) <br /> -�lX---- -- �'fib)---------------------------------- - ----------- <br /> By:---------- a•--- <br /> ' (Plot plan, showing size of lot, location of sys+e to we uildings, eft., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -- - - - ----------- ------------------------------------- DATE---- .'/0I--------------------------- <br /> LREVIEWED BY---------------------------------_--------------------- ----------------------___ ---------.... DATE----------...-----------------I.....I------------------ <br /> BUILDINGPERMIT ISSUED----------_--------.......................................----------------_-------------__ DATE-' -----..... ------------------------------------ <br /> LAlterations and/or recommendations:--------------------------------------------------------------------------------------------------------------_---------------------------------- ------ <br /> -------------------------------------------------------- ----------------.. ---- -_-..------------------------------------------------------------- - ----------------........-------------------- <br /> -----­------------ -- -------- ' - / <br /> FINAL INSPECTION BY. .. Date- !7.."��- ao J - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Haielton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi,California Manteca,California Tracy, Califoraio <br /> CS 9 REVISED B-.9 3M 3-'63 r.P.Ca. <br />