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qRI)F E USE: <br /> -------------------- <br />---------------------------- ---------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No.----------- <br />----------------------------------------------------:--- (Complete in Duplicate) C�� Issued --- <br />----------------------------------------------- This Permit Expires I Year From Date issued <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein descried. <br /> This application is made in compliance wi h unf y,Ordinance <br /> - ------ -- --- <br /> ----- -----I -- ---- I---------- -­ ------- •--- -------- <br /> JOB ADDRESS ANJDCATION-------- ---- ---------- ­ Z7 <br /> Phone./ 1 <br /> --- ---------- <br /> ------ ------ --------------------- ------------------------ <br /> Owner's Name- <br /> --- ----------------------------- ------ <br /> Y_ <br /> Address------------_----------- Z.=3 A 14 ----------------- ----------- <br /> Contractor's Na;e__�___ _1._1w_u�14.....8).6J----------------------------------------- ------------------------------------------------- Phon ---------- ...?^ <br /> Installation will serve: Residence Aparlment House T1 Commercial [] Trailer Court El Motel 0 Other E] <br /> Number of living units: -)..... Number of bedrooms -- Number of baths -------- Lot size _--&0—K_1Q.p------------------- ------------- <br /> Water Supply: Public system' Community system [I Private 171 Depth to Water Table44V ft. <br /> Character of soil to a depth of 3 feet: Sand []-.Grovel 0 Sandy Loam 0 Clay Loam E] Clay E] Adobe,, Hardpan 0 <br /> Previous Application Made: (if yes,date------------- ----) 0 E] No <br /> ❑ <br /> -:No New Construction: Yes ❑ No X PHA/VA. Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitfi§d-if public.sewer is available'within .200.feet.j. <br /> Septic Tank- Distance from nearest well------ -------- Distance from foundation-----_------_---Material------------------------------------------------- <br /> E]gl(,604 No. of compartments--------- Size--------r:-•- •----------------Liquid depfh--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well----------- Distance from foundation---------------_--Distance to nearest lot line---__---.._--_ <br /> ------------------.-.Width of trench----------------------------------- <br /> 171 Number of lines---------------- ---------------- -Length of each line------- <br /> -------------------- <br /> Type of filter maferial__ Depth of filter material.."-------------------Total length.._...._........__--....--------.-----_--- <br /> -A10 Pill , ion--.2-47' ,Distance to nearest 1�ljtt line-_ ........... <br /> Seepage Pit: jj Distance to nearest well----------- --Distance Aom foundat <br /> Number of pits-_Ct�_ --------Lining r�6feria Diameter-33------------- ---1.1---S------------------ <br /> ---Size Depth <br /> Cesspool, Distance f�on; nearest well-----------------Distance from foundation.-------------------Lining material-----------------------------------is, <br /> El Size: Diameter- ---------------:-------------Depth----------------------------------------------------Liquid Capacity..--.-..._-..--_-----------go <br /> Privy: Distance from nearest well-------------------------------------------- ----Distance from nearest b I uilding----------------- ------------------------ <br /> Distance to near i est [of line--------_ ------------------------------- ---------------------I-----------------1----------------------------------------------------- <br /> ❑ <br /> ---------------- --7-e...... -------------------------­---------------- <br /> Remodeling and/or repairing (describe):-----6 <br /> ------------------------ --------------------------- <br /> -------------------------------- ------------------------------------------------------- --------- <br /> --------------­I--------------------------------------------- i ----------- <br /> , I -------------------------------­ ---------------------------------------------------------------------------------------------- <br /> ------------------------------I--------------_------- ------------------------ <br /> ---------------------------- --------------------------------------------------------I------------------I-------------------------------- ---------------------------------------------------------------------------- <br /> I hereby certify that I have prepa-i f his-6pplicatio'n and that the,work will­lii--do66_in accordance w.ith San Joaquin County <br /> ordinances, State I an rules an elulations of the San Joaquin Local Health District. <br /> Al <br /> tlel <br /> (Owner and/or Contractor) <br /> (Signed ---- -------------------------------------- <br /> ---------- <br /> ------------ ------------- ....... ------------BY:--_----------------- <br /> -k----- --- ------6.............. :---------------------- ----------------------------(Ti <br /> (Plot plan, showing SIXG of lot, location of systern1n relation to wells, buildings, etc., can be plaicon reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> - --- - ----- --- ------------ ------------------------------ DATE------ ---------------------- <br /> APPLICATION ACC <br /> REVIEWED BY---------------------- - ------------------------------------- DATE. <br /> ----------------------- <br /> ------------------ --- ---------------------------------------- - <br /> BUILDINGPERMIT ISSUED------------------------- ------------------------------------ DATE------------------------------------------------------------ <br /> Alterations and/or recommendations------------------------------------ --------------••-------- ---------------_--------------------------------- _--------------------- <br /> ..... - ­---------------- ­ 9 <br /> ---- -------------- ......... ------------------- ------­------ I-­ ------------------ <br /> - ----- ------6.7.... .. -------- <br /> ------------------- <br /> r__. <br /> ------------------ <br /> ----- -- --- - ----- <br /> 7 t ---------------- ---------------------------------------------- <br /> ------------------------------------ -----------------------------------I----------- ---------------------- ------------------------------------------------- <br /> --------------- -------------------------------- --------------------------------- ----------------------------------------------------- <br /> ---------------------------------------------- ----------------- ------------------- <br /> FINAL INSPECTION --- Date---3' ------- ---------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E9-9 pEV.SED 13.59 rj-.rCh.2M 0-60 <br />