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0�, FOR OFFIE VSE- <br /> I.Yez <br /> 7W------------------------------------- APPLICATION FOR SANITATION PERMIT No. ...../ 7 <br /> Permit .........L....... <br /> ----------­---------------- --------------------------- (Complete in Duplicate) <br /> !� - - - - r. Date-Issued ....... <br /> ----------- --------- -------------— - This Permit Expires 1 Year From Date Issued ----------- <br /> -------- ------ ' k <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install Vq- worVlherein described. <br /> This application is made in compliance with County Ordinprice No. 549. <br /> JOB ADDRESS AND L I0N_'___- <br /> .•! ------------------ ----------- ------------- ----------­-------­--- <br /> Owner's Name.----- .. ......... <br /> -- <br /> Address--------------------- ... -------- <br /> ------- <br /> Contractor's Name - --- -------- ------------------------------- Ph <br /> � <br /> Installation will serve: Residence Apartment House EL C *a[ E] Trailer Court 0 Motel [3 Other <br /> pmmerci El <br /> -ja r� <br /> Number of livin units. --)---,Nurnber of bedrooms.1KNumber of baths __/---- Lot size ------ -------------------- <br /> 9 <br /> I. Water Supply: Public X�system c ommun'ity system ❑ Private ❑ <br /> -L Depth to Water Table &-'d ft. <br /> Character of soil to a depth of 3 leet: Sand Gravel Sandy Loam E] Clay Loam 0 � <br /> Clay; dobe 6--Hardpan F] <br /> Previous Application Mide: (If ytes,clate-------------- -- -- ' � <br /> No [I NowConstruction: Yes E] No FHA/ Yes [] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic-tank or cesspool permitted if public sewer.is available within 200 feet.) <br /> a Distance from -nearest well-----------------Distance from foundation......._.__.._..._..Material-_--_---___-_------ --..__ <br /> No, <br /> aterial-----------0---------------- <br /> No. of compartments...-----------------------Size-------------------____.__:-_.Li uid depth------------000-----------Capacity------- ----------- <br /> Ve c ---- <br /> ts e Distance from nearest well+40#&---Dis�ance from Distance to nearest lot line.._... <br /> Number of line!.... Length <br /> f each line_,=C___ of trench_42-51 <br /> Type of filter 'mate 0 material-:-K-' Zip <br /> -Depth of filter mater I---jK-a------- ---Total length_-------_ <br /> CN <br /> Seepage Pit: Distance to neares wen"li".__ <br /> 11_140.44�•----------Distance from foundation-le Distance to nearest lot line-.- <br /> of pits.:-/--,--------------Lining maferial,_94CA--- -_-.Size: Diameter.=r------------Depth_ 47r----------- <br /> Cesspool: Distance from nearest well------------0------Distance from foundation-___--____.______.Lining material..__--------.,--___-__-----_-.---_._ <br /> ❑ <br /> aterial....0--------- ------------------- <br /> El Size: Diameter-------------------------------- -.--Depth----------------------------------- ----------------Liquid Capacity--------------•-•-----------gals. <br /> Privy: Distance from nearest well------------------ -..'.-Distance from nearest buildin <br /> 4— ---------------------- <br /> 'Distance to nearest lot line_�--------------------•-------------------`----=------•-•---•-•• <br /> f Remodeling <br /> ----- ------ --------------------------------Remodeling and/or repairing (describe)` -- - --------- <br /> / . ------------------- <br /> & ------- ------ --------------- ------------------------- <br /> ----------- ----- -----------------------•-----------•---•••--•-------------•-•-•------------------- <br /> ---------------------------------------------------------- f__-------------..,--•-------- <br /> ---------- - -- - ------------------------------------------------- <br /> ----------Z----------------------------------------------------------------------------------------- ------------------ ------------- --------------------------------- -------------------------------- <br /> I hereby certify that I have p6epared this`application and that.the work will be done in accordance with San Joaquin County <br /> ordinances, State la 'and rules and repulatioils of the San-Joaquin I=] Health District. <br /> ---4K <br /> (S i g n e Z"!n'.' --- ---t- (OwmewwWoev Contractor) <br /> ---------------------------------- <br /> A <br /> By:----------------------------------------------------------------------------- <br /> '-------------- Kroo.. .....(Title)----- -------------------------- .......... ............. ff <br /> (Plot plan, showing size"of lot, location of system in relation f� ells, buildings, an be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----r(IZAk---------C,00---- <br /> --------------------------------- DAT <br /> E------- .. .... ..( <br /> ------------- <br /> REVIEWED -3Y_- -------------------------------------------- - ---- ------- DATE <br /> BUILDING PERMIT ISSUED------------ <br /> ------On------------------ -------I------------------ DATE ---------------- ------------ <br /> --------------------I---------------------------------------- ------------------I---------------------------------------------------- <br /> Alterations and/or recommendations:: --------- ------ 1-Q...... ------ <br /> -----•--••-----------•--•------------------------ <br /> -------- --------------- <br /> --------------------------------------------------------••---------- ----- ------------------------..---•------------------- ...... ------------------------------------•----------------I------- --------------------------- <br /> ----------- --------------------------------------------------- ------------------------------------------------------------------------------------------------------------ <br /> •-------------------------------------------- <br /> ------------------------------------------------ ------- ------- -------------------- <br /> ----------------------------------------- <br /> ------------------------------------ ---- --------------- <br /> FINAL-INSPECTIO . ........ <br /> N BY:_ .. . ... <br /> Date--------___- <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 />