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FOR OFFICE USE: - mit No <br /> P <br /> tar <br />------"--------------- APPLICATION FOR .SANITATION PERMIT ,.a: <br /> - - -- - - - - �„ sued t/2 <br /> r <br /> - ., (Cotm hate in Duplicate) -, • -Date``Is <br /> ----- .. <br /> . This Permit-Ex iresrl,,:Yea� Frorn Date Issued <br /> b made to the San Joaquin Local Health District for a-permit to construct,and install the work herein described. <br />------- <br /> This <br /> Application is here with County Ordinance No; 549. <br /> This application is made to compliance- 1�.��,� <br /> p !� <br /> 5` o NA A --------------------------------------------- ---------- - <br /> JOB ADDRESS AND LOCA ON------- -- Phone------------------------•----------- <br /> - `-A��_r --------------------------------------- <br /> jI/LL/P ---------•-•---------- <br /> Owners Name---------- S •_ �� � r <br /> uu - Q.- <br /> Address----••------------ Q n L_ _i ---------------------------- Rhone....... -----•---•--•--•-------- <br /> Contractor s Name---Qw(o- -r - - -- Trailer Court ❑ Motel ❑ Other ❑ <br /> Apartment House ❑ Cammer 4..T <br /> Installation will serve: Residence # <br /> Number of living units: __�__._ Number of bedrooms Numb& of baths.�.. Lot size --.-����� <br /> ool, it s stem ❑ Private❑ Depth to Water Tableta- <br /> Water Supply: Public system Y Y y Clay Loam [3Clay E] Adobe❑ Hardpan ❑ (` <br /> Character of soil to a depth of 3 feet- Sand �C9ravel ❑ SandLoam ❑ Y No VA: Yes ❑ No <br /> ❑ FHA/ <br /> lication Made: (If yes,date_------- -- --) No New Construction: Yes <br /> Previous App <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> L, .�[NoTseptic 4ank_or cesspool_permittedrifTpublicaewer is-availabieyithin 200 feet. , <br /> Ca acit <br /> .Distance from nearest well �'.�_Distance from founds#ion_��"-_--�---- -.Mate Material <br /> ------------------ - <br /> Septic Tank: Size .y__X/p--x- -�tiquid depth...._ p Y <br /> F. ��4RTE No:-.of compartments T <br /> Dis osal Field: Distance from nearest well---------- ------Distance <br /> ofreach line foundanon--------------------- W dthcofttrenchest lot line----------------- <br /> Disposal <br /> _-. --•----:--•_ <br /> 1 p Number, lines__"-__._-_._ <br /> ❑ •-- ----Length <br /> ,Type of filfier material--------------------- --Depth of filter materia-----------------------Total length---.--------------------------------------- <br /> Type <br /> _---. ""-:--------- -------------""-" <br /> I' pi{; Distance to nearest well_.-.--_.'--------------Distance from foundation._"-__--___.----- <br /> Distance to nearest lot line--------------- <br /> -- <br /> Seepage <br /> Size: Diameter----------------------Depth---------- -------------- <br /> ❑ 'Number of pits.;. ____.._._________Lining mafierial__._._'..--_. --- --- <br /> Distance from nearest well ._.______._----Distance from foundation................. ..Lining material------------------------- -- als. <br /> Cesspool: Liquid Capacity g <br /> Size: Diameter_JI- Depth----------------- <br /> Distance from nearest well-------------•--.- Distance from nearest building--------------------------------- <br /> Distance <br /> ."-_------------"----- --------------- <br /> r.,'. . <br /> Privy: --•------ ---•- 'S <br /> ------ - <br /> Distance to nearest lot line :"_"- -- " <br /> } ❑ -----•---- -- <br /> ------------------------------- <br /> Remodeling and/or repairing describe -------- ------------------------------------ � -------------------- --------------------------------------- --------- <br /> -------------------------------- <br /> ----------------------------------- <br /> i .! -+ <br /> - <br /> and that <br /> ! prepared this np off thtan an Joaquin LocalHealthDistrict. <br /> � n accordance with San Joaqui <br /> I hereby certify that I have n County <br /> ordinances, State laws, a rules and regulations <br /> r 4 ---------------------(Owner and/or Contractor) <br /> ----- ---------- -- ----- ------- <br /> ---------------- - <br /> { y <br /> -------------- <br /> (Signed) til <br /> — <br /> _ - � �. ....r-r...- <br /> Plot Ian, showing size of lot, location of system n relation to wellS. <br /> uilditigs, etc., can be placed on a reverse side). <br /> 1 FOR DEPA TMENT USE ONLY <br /> r DATE. ��'~ l9-`�� ------------- <br /> APPLIIATION ACCEPTED BY.___.- 1 --- - <br /> REVIEWED By-------------------------- ------------------ --- ----- - <br /> DATE <br /> _ DATE --- ---•----------- ----------- -- -------------- -- <br /> BUILDING PERMIT ISSUED-- = ---------------------- ----- ----------- "- ---------------- -- --------------- -------- <br /> - ----------------- <br /> 1 $;. $_...�—� app'-e . G_- 'r <br /> %� 4. ----------- <br /> 'A%5_0 ---------- <br /> Alterations and/or recommendatioins � �- <br /> ---------- --------- <br /> c - - -------------- <br /> ,.-- -- --- -- <br /> -- <br /> ------------------------------- -------------------------- <br /> ---------- <br /> r` n .. ---- :----- ---- --- <br /> -- ....... . <br /> ----------------............ <br /> Date-- ---------- ------- ------------------------------ <br /> FINAL INSPECTION BY:- --------------- <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> A 2p5 West 9th Street <br /> 300 wait Oak Street 124 sycamore street <br /> �. 1401 E.Haselion Ave. Manteca,California Tracy,California <br /> Stockton,California <br /> Lodi,California f <br /> r E.H.g 2M 1.67 Vanguard Press <br /> c . <br /> 6 <br />