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FOR OFFICE USE: <br /> --------------------- --- - Permit <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date lit <br /> uec3 <br /> - _ This Permit Expires 1 Year From 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. • 4 <br /> This application is made in compliance with County Ordinance No. 549. N _/�f j ee+, <br /> cJCUtj�.q(2:0 - ----------------------------- - <br /> t�� �j. -- --- {D <br /> JOB ADDRESS AND LOCATION------ _��---------�'u-'4'ie -�----!--i------------- <br /> -� <br /> Owner's Name L ` ------- `---------------- - e ----- <br /> Q v e" Q d l�Ss--------t-n - �=r�Le_�!1�------ <br /> Address----------•--•-- --- <br /> F Phone------------------------------------- <br /> Cor Tractor's Name---------I--•---------------•--�3-cif.-------- <br /> [ICommercial Trailer Court <br /> Motel ❑ �Other <br /> Installation will serve: Residence .� Apartment House El ❑ <br /> Number of living ui ---2— _1---dumber of baths _ --. Lot size. _-------------------- <br /> units: _--.�-_ Number of bedrooms --•---- <br /> I ar <br /> Water Supply: Public system EK% Community system ❑ Priva}e ❑ Depth to Water Table,-------- ft. } <br /> Character of soil to a dei+h of 3 feet: Sand E] Gravel ❑ Sandy Loam JZ Clay Loam ❑Clay C] Adobe❑ Hardpan❑ <br /> FHA/VA. Yes [INo C]Previous Application Made: jIf yes,date_-'�EX,4-t No New Construction: Yes l� No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: c k,} <br /> No septic tank or cesspool permit+ed if Pu lic s WSJ is available within 200 feet.) < ` <br /> F — - ( _.,rp Ma#�al--c--- •---- -- ------- <br /> Septic Tank: Distance from nearest ell- . - -Distan'e from foundationq- p ---------------------1 Capacity.--1��- ----- <br /> No. of compartments------a----------------Size----AX__P. X',�-Li yid de th <br /> Disposal Field. Distance from neazrest well:"----- istace from•foundation..- ------Distance to nearest lot line-----15--_.---. � <br /> Number of lines--_..--'"" -:- 1�--------Length of each fine__-:_..' ------------Width of trench..-...-{: ------ � <br /> I <br /> Type.of filter material✓_- ------Depth of filter material-..--__t-- .---------Total length------ ----- <br /> Seepage Pit: Distance to nearest-well- ._-_-.-----__- Distakee from found (ation___________________Distance t-- nearest'----- line----_--.-...--... <br /> e th �. <br /> ❑ plumber of pits...---- ------Lining material---" ie: Diameters- DP <br /> Cesspool: Distance from nearest well--------------- Distance from foundation----.__--_._-.--.--.Lining material.¢.--...------ 'a7s. <br /> C ----�, <br /> Size: Diane#er---------------------=-- --------- -Depth-------------------- ---------------------Liquid apacity <br /> ---------•-- --------- <br /> ❑ s�,. �• <br /> I ance from nearest building.-----L ---- ; SJ '" <br /> Privy: Distance from nearest well--------------------------------- -------- -- -------------- <br /> .-Dist ,..r <br /> to nearest lot line-. ----_-----"_------------------ - - <br /> ------------- <br /> Distance. — , <br /> Remodeling and/or repairing (describe):-------Y------------------- --------------- ----------------- o _ <br /> roti �� �� <br /> TR JL4`2 C r c �.J�c�:-_ _-- - --e ---- --------�. _. <br /> - --- <br /> 13_.rz `"� ---------- ...'-----------------=- --------------------------- <br /> /if <br /> ----- ------- - <br /> � - rjx — —�7�-=-SVM_:P--- .. -------- -- <br /> I hereby certify that. I hev+a prepared this application and that:the work will be donein accordance with San Joaquin County <br /> ordinances, State laws, and rulesVandrelotions of a San .laaquin•,Local.Health Dis+ric#. <br /> - - -------------------(Owner and/or Contractor) <br /> (Signe t '` (Title) <br /> By:---•-----------------' ------------------------------------------- F,=------------------------- ( e} <br /> t <br /> �..�... . <br /> Pla+ len, shawin size;,ofJot, location of s s+em;in relationtta wells;buildings, etc., <br /> -can�be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> DATE------ . <br /> APPLICATION ACCE TED BY---------------------- DATE---------------------------------------- <br /> ---------------------- <br /> D <br /> _ k-------------------------i--------- <br /> REVIEWED BY_ _ - <br /> --------------•---•--- <br /> BUILDING PERMIT ISSUED DATE------ ---------------- ;-.._-....----- <br /> 1 <br /> Alterations and/or recommendations------------ -- --------------------- ---------------------- ; <br /> ----------- -- -- <br /> 4 <br /> .•--.._-r--------------------------�.-------.._-..--------_--•----.•------.---------_-.-_•_--�-.-----.-- -----_-.._--•--.___- <br /> ..-.--•_-------------------------------• •-_•_•---•-•-- ` --.._-_-••--_• ------------­ <br /> ------------- <br /> ----------•- .. <br /> F <br /> i <br /> .a - � wwwa�Y•vb rr 'DIY' � - y�. .W, <br /> Date-------- --- --- - <br /> I <br /> FINAL INSPEC`TIQf1L ,, . ... • - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 weft Oak Street 124 sycamore Street 205 West 91h Street <br /> w 130 South American Street Tracy,California <br /> Stockton,California <br /> 1 Lodl,California Manteca,California <br /> ER-9 REVIGrC B-59 F.PX0.8M 6-613 ry 3 µ <br />