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10 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued ..Z41.12 7/,F; <br /> Application is hereby made to the San Joaquin Local Health Dist rict'for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIOW r. <br /> ----------- <br /> Owner's Name ,`-/---- -------AOF-----------tv"_114_11.1 ---------- _.Rce ----------------------- <br /> JAZ---------- - --- ---------------- -------------------------------------------- Phone----------- <br /> -------------- <br /> Address-------------------- i A <br /> -------------------------------------------------------------- <br /> Contractor's <br /> ----------_Contractor's Name--------- <br /> .. . ......... . <br /> ----------------------------------------- <br /> Installation will serve: Residence Apartment House 0 Commercial El Trailer Court E3 Motel 0 Other E] <br /> Num'ber of living units; umber of bedroo q <br /> J_ NNumber of baths Lot size &VA4p <br /> ms <br /> Water Supply: Public system 1,Communify system El Private C] Depth to Wafer Table ft. <br /> f�,. !V"I -1/b <br /> Character of soil to a depth of 3-fdef: Sand 0 Gravel E] S8ndy Loam E] Clay Loam E] Clay E] Adobe <br /> E] No Hardpan 0 <br /> Previous Application Made: Yes <br /> f lk New Construction: Yes E] No PHA/VA-. Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ..(No septic tank or'cesspool permitted if public sewer Wavailable within 200 .feet.) <br /> fic Distance from nearest well_____________ <br /> . No. of cornpartments":--.---.,-- ----Distance from foundation___:______________Material_.-__._:________ --------------------------_- <br /> -----------------Size Liquid depth--------------------------Cap;acity-__' <br /> ---------- ------- <br /> DA' po,al Distance from nearest well_.7tAVj"1_Di`stance-from,founclatilri___.,X47_------Distance to nearest lot line _ 4��.....wr <br /> Number of lines_--.______ _ ------------Length of each line---- Zo......7---------Width of french--- 09 <br /> �-? <br /> Type of filter material_____-;_P47C1e___Depfh of filfer.material----X I............Total length------IZ-a------------------- <br /> X <br /> j5fa�'E <br /> Distance to nearesi­1elI_____WX04,___D e from founclaticn--.2 -------Disfance to nearest 10' t line---00? <br /> Number of pits-------:-------------I Lining' Diamet6r---- ..........Depth.. 011 , 11 <br /> T --- ---------------- <br /> Cesspool: Distance from nearest Well.............:---D;sfance fr6m;foundation----------------._Lining material-_.________._______._-_____.________Size: Diameter-------f--------------------- -------Depth------------------------------1-------------------_-Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest'well-----I---------1_---------------------------M".-Distance <br /> from nearest building------- ---------------------------------- <br /> El Distance to nearest lot-line. .-- -------------- ----------- ----------------------------------I-------------- <br /> Remodeling and/or repairing (describe)------ -------------------- <br /> ------------- <br /> ------------- ------------------------------------------------------ --------- ----------------------- <br /> ------------ <br /> ------------- ------------ ------ <br /> ---- _ ------- <br /> ---------------------- <br /> --------------------- ----------- <br /> �eg `, ----------I-------- ----- -- <br /> ------------------------------------------------------------------------ -------------------•--------•--------------------------- --- -- --------- <br /> ------------------------------------------------------------------------:-------------- --- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County .7 <br /> ordinances, State laws, and r and regulaf!a95-0", San Joaquin Local Health District. <br /> (Signed). <br /> ------------------------ -------- ----------f--------------- <br /> ------------------------- ---- <br /> ------------j-----(Owner and/or Contractor) <br /> -- - ------ ---------- <br /> By----------------7----------4 <br /> (Plot plan, showing size o ------------------------- ----------- <br /> f lot, location of system in relation to wells,4Wild;ngs, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------- ---- --- . . <br /> REVIEWED BY------------ -------------------------------------------- DATE---------------------- ----------- <br /> ------- ------------------------ - ----- - --------------------------------------------------------------- DATE- <br /> BUILDING PERMIT ISSUED__________________ -1-----------------­----------- <br /> ---------- ------ --------- <br /> Alterations and/or recommendations:__"_ ------------------------------------------------- DATE_._.__ <br /> ---- --------------------------------------------- - <br /> ---------------------------------------------- --------- -------------------- --------------------------------------------------------- - ---------------------------1*------------**--I---- <br /> ------------------------------- --------------------------- --------------------------------------------------------- -------------------------------------------- ------ <br /> -------------------------------------------:1-------------------------------------------------------I--- ----------------------------------------------------------I------------------ ---------------------------------------- <br /> --------------------------------I-------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- <br /> ------------- ------------------------------------------------ 7-1---/�----------------------------------------- ------------------------------------------- <br /> FINAL r INSPECTION BY:_____:..:_ - t4. -----= Date----_- <br /> --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American'Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 1.57 EPCO, <br />