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FOR OFFICE USE: li <br /> 6;� /a.a o . APPLICATION FOR SANITATION PERMIT <br /> Permit No. -A-1-i-12---- <br /> ----------------------- -------- <br /> _.:C-1-rl__.12---------------- ------- (Complete in Duplicate). Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for alpermit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ;I <br /> �� �ry ------------------- ---------------- <br /> - <br /> JOB ADDRESS AN OC TION - 0---- � ' <br /> Owner's Name---------- -- '�. '1� -------------/4= ...... <br /> Phone--------------------------------•--- <br /> Address J - ----------------------------==--- --------------------•----------------_.----� - --m{------------------------•---------- <br /> - - -- ,� <br /> --------- <br /> Contractor's Name -. � ! 4 - .................... - ' _ Phone <br /> Installation will serve: Residence V3.1,Apartment House [ICommerciallrE]Trailer Court E] Motel [I Other ❑ <br /> Number of living units: --/.. Number of bedroom __ ls r.Number of baths _ --- Lot Lot size -a- <br /> ---------------------------------- <br /> Water <br /> ----------------------------Water Supply: Public system ❑ Community sys fe.o- Private [p, Ipepth to Water Table <br /> I Gr <br /> Character of soil to a depth of 3 feet: Sand 12 avel E] Sandy Loam El .Clay Loam [ICI y:•'❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,,d-ate��-..__.._..-} No 2-` New Construction: Yes [INo ©,FHA/VA: Yes ❑ No - <br /> L f <br /> TYPE OF INSTALLATION AND SPECIFiCM.IONS: t 1. <br /> (No septic tank or cesspool pe mi+ted if,�p <br /> ublic sewer is available wii+hin 200 feet.) L <br /> Septic Tank:, Distance from nearest well--------_ Distance from foundation__ __.__._______-Matenal____.___________________________________________ <br /> �I �6 1 No. of co partments------- N �;'....Size---------------------f----------Liquid depth--------- ---------Capacity--•----- •--------- <br /> # P'l � <br /> Distance from foundation_-_� ._--.....Distance to nearest lot line __-----_ <br /> Di�osal Feld: Distanct=-from nearest well... <br /> . 1; . f---------------Width of trench-- ----------------------------- <br /> -------------------------- <br /> T <br /> .--------------------------- <br /> �(.'' ��1 Number of lines-------------------- ----- ----•. L'ength of line--__ -- - . <br /> f � -- gyp,..,, �r <br /> ` Type of filter material-_�_�a,/�.� E Depth of filter material___,1 ..__----..Total length_____ ____________________�__ <br /> *�- 7 . <br /> t' distance fr fo dation___ is a ce to nearest lot line-2'P------ <br /> Seepage Pik: Distance to nearest well...1 Pe-�. — - r <br /> Size: Diameter_ �� -----Depth_ <br /> Number of pits----- -------------Lin1ng;mate-rrai_ _ e-g <br /> F <br /> f� �. �l <br /> 00 <br /> Cesspool: D nce from nearest well---------------':Distance from foundation---------- ------._Lining material__------:---------------------------- <br /> = <br /> f ---------------D'e th' 1 --------------- -----------------Liquid Capacity------------------------- -gals. <br /> y ❑ Size,: Diameter pd IS. <br /> a ce from nearest well-____-:._- -. <br /> _----_- <br /> Privy: Dist ------------ Distance from nearest building-_ <br /> ❑ Distance to nearest lot line-------------------- - -- <br /> IM. : ---------------------------------- <br /> Remodeling and/or re airing (describe) '------------------ <br /> '--•--•--------------•-------•-------------------------------- <br /> tI -----------------------------------:'F__ <br /> I -------------------------------- ------ ---------------------------------------------- <br /> =----------------------•------------------------------=----- W----------------------------- <br /> I <br /> = `a <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 3 <br /> ordinances, State laws, and-rules-and reglul tions of the San Joaquin Local Health District. <br /> ,��- i -for Contractor <br /> F (Signed) y%c�sc ------- f <br /> _ x <br /> g 'f ------------------ <br /> ` -----------(Title)-{rte-�� ------- ------------- <br /> - <br /> Y=•----------•-------------------------------- <br /> (Plot plan, showing size of lot, locati•orn of system i lation to wells, buildings, etc., can be placed on reverse side). <br /> I9 / FOR DEPARTMENT USE ONLY <br /> ' I� .DATE_ �' - <br /> i.APPLICATION ACCEPTED BY-------•-- -�c-�. <br /> REVIEWEDBY--------------------------------------------------------------------- ------------- IM - DATE <br /> I <br /> BUILDWG PERMIT ISSUED------------ - - DATE---------------- ------ -------------------------------- <br /> i <br /> --`. <br /> : . � ------------------------------------ <br /> yr <br /> -----------------------• <br /> ------ <br /> iy=Alteratndrecom endatios:__..__.._-- -------------(; � <br /> rl ------OX ---------- ------I---- ---------- - --------------•-----.-.----------------------------------- <br /> r---- -------------- <br /> R-- ..-- _-----_---------- <br /> ----------- <br /> ----­---------------------- ------------------------------ -------------- <br /> --------------- <br /> ('r/7 I Date----- -- _X------ -- ---------- <br /> FINAL INSPECTION BY:.......C. lr.ca'---------------- ------ <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haselton Ave. 300 WX-Clak Street 124 Sycamore#Street 205 West 9th Street <br /> Stockton,California Lodi,California I Manteca,California Tracy,California <br /> c.a.co. 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