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0 <br /> APPLICATION FOR SANITATION PERMIT Permit No. _&QA�t...... <br /> • (Complete in Duplicate) Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with ounty Ordinance No.-549 14 �1!r <br /> — 4 -)0; --------- ---------------------------------- <br /> JOB ADDRESS AND LOCATIO <br /> Phone------------------------------------ <br /> Owner's Name--------------- --------- --------------------------------------------- --------------- <br /> -----•----- 4pe !n-------------I------------------------------------------m-----------------------------------------------------I------ <br /> Address------------4r <br /> Contractor's Name-- -•--- -------------------------------------- ----------------------------------------- Phone----------------------------------- <br /> Installation <br /> hone----------------------------------- <br /> Installation will serve: Reside ce 7j,--Apartment House [] Commercial E] Trailer Court E] Motel [] Other E] <br /> — Of <br /> Number of living units:1_1--- Number of bedroomsf--- Number of baths -4--- Lot size -------- ----------------- <br /> Water Supply: Public systemj�E] Community system Private ❑F <I f" , <br /> ] Depth to Water Table P,5! ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam E] Clay Loam [] Clay El Adobe arclpan C3 <br /> Previous Application Made: Yes E] No PNew Construction: Yes [I" o E] 'FHA/VA.. Yes ®�'No 0 <br /> TYPE OF INSTALLATION AND I SPECIFICATIONS: <br /> 411 <br /> (Nonseptic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from,. nearest w4___'-----__Dista e from.foundatton----11P-------Material--- - ------------- <br /> of �d?nprartr;ents------x------- <br /> ----SiLiquid de0h----- *-------------Capacity.. <br /> No Ze -------- <br /> Disposal Field: Distance f',rom nearew'ell.... ------------Distance from foundation__-i��------- -.Distance to nearest lot line____-____. <br /> Length of _!�---------------Width of --------- <br /> Number of lines____._-- each line <br /> -------------- <br /> Type of filter materia - - - -----Depth of filter material---- ______--_Total Ieng1h_____14 --- <br /> C ---:----------------- <br /> 7 <br /> �slance to nearest ------ <br /> See a Pit: Distance nearest well.-------------I--------Distance f om fot.Lndation__1r,;__P-------D' !St �f line--_Ix--- <br /> xo, <br /> Number 0 'its. Size: Diameter- --- Depth--- <br /> p -.P—------------Lining ------- <br /> mate ri a I <br /> Edi <br /> Cesspool: Distance frSII om nearest well-----------------Distance from foundation----- ------------ Lining material--_----..-_--_._----_-_-._--__------- <br /> Cter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- <br /> ❑ Size: Diaffiq <br /> Privy: Distance from nearest well----------------------- ---._.-_Disfance from nearest- building-----_._-_-- _r--------------------------- <br /> ❑ Distance nearesf'lot line------------------------------------------ ----------------- ------I---------------------------------------------------------------------- <br /> r w <br /> Remodeling and/or repairing (clescribe):-----------xa_141�0&----- - - ---------------•-------------------•---------------------------- ---------- <br /> A <br /> ------------------­---------------------------------------------- ----------------------------------------- --------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------- ---------------- ----------------------- --•------------------------------------------•------------------­ ------------------------------------------------------ <br /> ------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------- <br /> I hereby certify that I ha e prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rifles and regulations of the San Joaquin Local Health District. <br /> (Signed)_-__ - -------- -----------_Qwnergj�r Contractor) <br /> : ---- ------ - ---- --------------------------------------------------------- <br /> By:-------------- <br /> G� -------------------------------------------(Title)--- ------ ----------------- <br /> --- --- ---- --------- <br /> (Plot plan, showing s�i1Ze__0f__1ot'1_locaf" of system-in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -9 .7 1--------------------------- <br /> APPLICATION ACCEPTED By__.—_-_rk_ 0 --- ------------------------=----------------------------------------------------------- --------------------------------- DATE------7,n: — <br /> REVIEWED BY-------------------------I - <br /> -- ------------------ ----------------- DATE---------------------- <br /> ---- ---------------- <br /> ---------------------------- ---------- ------------------ ----- -- -- ------ <br /> BUILDINGPERMIT ISSUED_-4------------------------------------ —------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:---P----- ------------------------ ------------------------------------------ -------- <br /> b----------------- - ---------- <br /> 124— ---c__)---Rs.--Z --------:=J.9-N- ---------- A-t------ -ixS�Q' <br /> ---------------------- ------------------------------------- --------------------V -----------0) <br /> ------------------------------------------------- -----------------a-0.........r_g_P_!--------------------------------------------------------------------------------------------------------I----------------- <br /> ----------------------------------------------------:---- -- - ---------------------- --------- -------------------------------------------------------------------------------------------- <br /> 11 -- -------- <br /> -------------------------------------------------- - ------ ---------------------- ---- -- --------------------------------------------------------------------=------------------------------- <br /> -- -------- <br /> FINAL <br /> ----------------:------------------------------- <br /> FINAL INSPE BY:. ------- Date--------7 <br /> ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sy6arnore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2 M Revised 1 S7 Filp,co. <br />