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FOR OFFICE USE: <br /> ......................... ------.................... <br /> ......................... .................. <br /> APPLICATION ,FOR SANITATION PERMIT Permit No. .1�.. <br /> :; <br /> ......................................................... (Complete in Duplicate) <br /> ________________________..................__!!..... This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and installs the work herein described. <br /> This application is made in 'compliance with County Ordinance No. 549. Ztz- /7'0 -q 2_ <br /> JOB ADDRESS AND LOCATION.C,>t1-+__YVD4---1Tzv ZWM_.fb&?A___3.--- ---. _I+A 41 ----Rip.................... <br /> Owner's Name---------------- -i '---.Capps..-_------------------••------- .................... ---.......................... <br /> Address-----------------0_•---...._!__ -66-0,------w ..._.._.--_-_--- ----------------.----•-•------------.------_-.-..-.-.-----------------•---•----•---•----- ..._.. --------_------- <br /> Contractor's Name----....... ----------------------------------------- ............................ Phone....----•--•--•--------- <br /> .,l <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other W'(%{gm <br /> Number of living units: Number of bedrooms .tr"". Number of baths ...0. Lot size ........__;1-.A...................................... <br /> yj. <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 10- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy'toam ❑ Clay Loam ❑ Clay (] Adobe 9--hardpan ❑ <br /> Previous Application Made: (If yes,date---------...........) No [ New Construction: Yes ❑ No FHA/VA: Yes ❑ No r—:t <br /> TYPE OF INSTALLATION 'AND SPECIFICATIONS: Amnow 4F h'FST RMH1 T13 CO*A(-m <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well...2-00----Distance from foundation_._../P-------- � ' f"_______________ <br /> No. of compartments...........Q...........Size__..,_.'40t._$x_ .._-:Liquid depth__... `___ _.... Capacity....goo <br /> l <br /> Disposal Field: Distance from nearest well._PCID-------Distance from foundation.(..___RP .-PP.PDistance to nearest lot line._I <br /> � <br /> Numoer of lines.,....._...- Length of each line-_ ia4� trench. <br /> .. Width of <br /> _-_ _ .wi�_ . � <br /> Type of filter material._.-f.. _J?4;4..__.Depth of filter material .....Total length......... ............................. <br /> Seepage Pit: Distance to nearest well.............._._._.Distance from foundation----------------- ..Distance to nearest lot line.__...._._-__.-_ <br /> [] Number of pits...... ...._.. Lining material _ Size: Diameter------------ _ _- Depth................................ <br /> . <br /> I. Cesspool: Dis*ance from rearest well_--------------.Distance from foundation ___.-..__.__ Lining material,__,................................. <br /> F <br /> Size: Diameter......................................De th_..__-__...._...._......_..._......_. -------Liquid Capacity. . _gals. <br /> L G <br /> Priv^'� D'istance from nearest well _....____.--------------------...._......Distance from nearest building g - - <br /> 1 ❑ Distance to nearest lot line--•-- ...__.......-•---------- --------•-• ---------------------- ---------- ------- ----------------------------------------------- <br /> ----.-.-.--•-••--------•------•----....------- <br /> 1 <br /> Remoeielin andj re airing (describe): fs._..(fimlf__wr.l�--- -- IIQ _-_-L'3)1ay---:"�' � r-'f}l$--.--L"f .1.21 .._ls..__... <br /> . �1 + . umilw.: 9,00y _. sas-rig .( -, <br /> .--------------------------- ­ <br /> ----- ------------.......... _-------......... . _ - - - ............ _ _ _..• ---- ---------------------------- <br /> -------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State taws. and <br /> rules and regulations of the San Joaquin Local Health District. <br /> �� ion <br /> (Signed)---- -------- ------- ------------------ ------------ -----------------------....._..-----•------------------ ------(Owner and/or Contractor) <br /> BY:-�-- --- -- ----- - ----- --.. -------...----- ---------------------..........,...._(Title)....... ------ -- -- _......(Plot plan, showing ' e of lFetaystem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED - DATE.. <br /> ! REVIEWED BY. ! ..... .__............. - -----------------• ---•---- -_.----- . _..--. .... ."' DATE... . ...... ... - <br /> BUILDINGPERMIT ISSUED.------•--------•-•..........................._-..---.-.,---------....__.....• •. ... ----- -- DATE.....--- ----- --------------....-•--................ <br /> Alterations and/or recommendations-&&......... <br /> �j`. i1, T..... 11 .:.p ................ ---- - <br /> -----•--------------.............. ---........_..._..---...........--.............................. ----- ---- ............. <br /> . i <br /> ............................................ ... ..............................I........._... <br /> t ----•-•-----•--------------- <br /> -�i <br /> FINAL INSPECTIO BY i:- ~.._. Date. .........................•-----...__....._......_ <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> 1601 E.ka:etton Ave 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Callfornla Lodi,California Manteca,California Trocy,California <br /> k' <br /> �.P.Co. <br />