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......... <br /> ----------­...............................I.._......... <br /> .1 APPLICATION FOR SANITATION PERMIT Permit*No. <br /> ................... .................................­.. , - <br /> ......... ..........................­-­.......... (Complete in Duplicate) <br /> .....................-........... ...... This*Permit Expires 1 Year From Date Issued Date <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and!instill the work herein described. <br /> This application is made-in compliance-a with County Ordinance No. 549. 2-Yg-- V-70,2,2 <br /> p -cpmp ipru <br /> JOB ADDRESS A ) L6CAT16N­ . . ... ... ..... <br /> ------ .... <br /> Owner's Na!Dq­r-x-- ------- ---------- .......................... .........................."­.......... Ple................I.................. <br /> Address..Arl'/ <br /> .... ............. .... .............. .......... ..............................;;�...................................................... <br /> ............................... <br /> 'Contractor's Name....... <br /> PKc;n—e <br /> Installation will serve: <br /> Resi A2Mc, Aparfmen� e [j Commercial [] Trailer Court M el Other <br /> dr <br /> Number of living units: ... Numb'r of be ooms -:Ndmbef of ba�hs`.IKLot size. ......... ..... .. <br /> �ie -1 '. ............... .................... <br /> Water Supply: Public system ❑ Community system ❑ Private D th t Wafer Table7 __ <br /> Character X of soil to a depth of 3 feet: Sand E] Gravel Sand -,ekoc _1 <br /> �' 111111 <br /> y Loam lay loam F Clay Adobe[3 Hardpan 0 <br /> Previous Application Made: (if yes,acite............... I No 0 New Construction: l`HA/VA. Yes 0 No OX <br /> 6-- TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> - <br /> -'*- oc able within 200 feet.) <br /> se-pfic-'f;nko;cessp�P;irWiff Z-4K-p- bcsewer islavailable <br /> Se is Tank: Distance from nearest well.&�.......Distance;froM/foundation.... 00 <br /> I - Me a]- <br /> No. of compartments...21depth....._.._ <br /> ...... Mate <br /> ...Capacity.__,/. ,_!, <br /> ............ Size quid dep�h...... ........ <br /> �7Disposal Field: Distance from neac.9%fZ.611....t5­!. bisfancel from founclar S f rest lot line <br /> t k 67-1--------------- <br /> Number of -lines...7---------------------­-----Length �f each line.- ------ .. t ench........!�...................... <br /> Type of fil4r material-z-�7—)-�- 4epth of filter material­ly---------Total le the <br /> Seepage Pit: Distance to nearest will......................Distance from foundation....................Distance to nearest lot line__..._....._...._ <br /> ❑ Number of pits._.....:,...._....Lining material.......................Size: Diameter_........._._.__......Depth---._-.-_.-__...__-..._.......... <br /> ' 4',,A r-, -- <br /> Cesspool: Distance from ne-aresl well­-`.. Distance from foundation....................Lining m iferial.................................... <br /> 0 Siz&-Diameter= --- ...................Li 3pacify............................gals. <br /> 4 <br /> Privy: <br /> Distance from nearest well.....,,. ...............................Disf6'nce from nearest buil c ing.............................I........... <br /> El Distance <br /> ---- ------------------------ ............I....... ............................. <br /> 7-4 <br /> repairing <br /> Remodeling and/or ....... ..er <br /> (describe):_._ <br /> 6Z <br /> .......... . <br /> ... ...... ......t.. ...... <br /> "1 -1. 1 I-e--Nrl.. ........... ------------------ <br /> ----­--­---­------------------------------------------------------------------- <br /> ... ............................. -------...................................................%1--­..................... .......................... <br /> I hereby certify that I have pr plrod this app4cafion and'Aaf the work will be done in accordainwith San Joaquin County <br /> ordinances, S+ laws, and rules a d!r6gula ion <br /> aw:s iiind rules. n gula,' s of the Sari J6aqu;n Upea[,Health District. <br /> ......-.......... (Owner and/or Contractor) <br /> (Signed)­...... . ....... .................. ........ ............. <br /> ............................................ ........................---------------- ----------------- .........—1.................... .......... <br /> (Plot plan, showing size Of lot, location Of system in relation to wells, buildings, etc., can be placed drileverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.......................... I—-..... .......... DATE........ <br /> ------------------ �` <br /> .................. .... ............................ <br /> ------------------ <br /> REVIEWED BY..-----•...............•....................... ............. ATE—- <br /> #-�)f--'I-- ------------ <br /> BUILDING PERMIT ISSUED.................. . .............. ........ ATE......... ...... ...I.. ......... <br /> ----------- <br /> ----------- <br /> Alterations and/or roc d .........��. ­ X... ,1--_-.__...Pm ions... <br /> ............................ <br /> .......................................................... <br /> ................................. ..................... ............/­ ••-•••--••--..........--•••-•.......................... <br /> .................................................................. -------------------•-------------------------•-----------i <br /> ----------- --.------------•-------------•••---------------•••-._._..._•---•....._......----._.... <br /> ...........................................-....._....••.....--.. -------- ---------- ----------------------••---••----•--=••...-•••-•....-----.......--••-••---..... ............. ............................. <br /> Date...............7=i,.,q-.-,64---------------------------------- <br /> FINAL INSPECTION BY:................. <br /> ­--------­-------------- ---­--------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naxotfan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />