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t FOR OFFICE USE:'.= �a' <br /> ^ 4 <br /> APPLICATION FOR SANITATION PERMIT Permit No.--------------------------------------------------------- <br /> --------------------------------------------- ---- (Complete in Duplicate) — <br /> Date Issued <br /> --------------------------------------- This Permit Expires 1 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 described. <br /> This application is made in complirice with County Ordinance No. 549. ;Z OP—3(pp— C) I <br /> - rCh <br /> JOB ADDRESS AND�' }OCATI -----hl M l - 1--- -------3vo-------ML-CE---- M--------��--------------------- <br /> Owner's Name---------- ----------- <br /> t/N_T aAL �� --------------------- ---------------------- —-------- <br /> - � ------- Phone------------------------------------ <br /> Address-------------------- <br /> ------------------•----------------Address-------------------- 5y)j-----------E---------f , T ---------My!T-�;A---- <br /> Contractor's Name----------FvLt <br /> --------------------------------------------------------------------------- Phone <br /> -----• --------- <br /> Installation <br /> will serve: .Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Ej Other [❑ <br /> Number of bedrooms ---- Number of baths .l-.-.- Lot size ---�f S ooQ---Q------------------------------ <br /> Number of living units: _j____ 1 <br /> Water Supply: Public system ❑ Community syste m El Private �epth to Water Table _-d_-_ ft. <br /> Character of soil to a depth of 3 feet: Sand LT Gravel E] Sandy Loam E] Clay Loam ❑ Clay E❑ Adobe E] Hardpan ❑ 41 <br /> 41 <br /> Previous Application Made: (If yes,date -------- ----------)' No P--&ew Construction: Yes V-;�`No ❑ FHA/VA: Yes ❑ No p <br /> r' <br /> 1 <br /> ''TYPE OF'INSTALLATION"AND SPECIFICATION <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---5PA-Distance from foundation..../0--.----.Material..-C-0/ -CREW ___-_-_` <br /> [� No. of compartments----Z--------- -Size- .1-0-X .-_Liquid depth_ <br /> �- !t f <br /> Disposal Distance from nearest;w�llx-'-_-_:_=--�pistance from foundation---./.0._-__..Distance to nearest lot lin��-----._--._... <br /> Q <br /> Number of lines-------- - Length of each -------Width of trench------ _-_._- <br /> t� l------------ <br /> Type of filter mate Depth of filter material.-__� ___________Total length----------1Q.._----__----_--_ <br /> Seepage Pif:` Distance;tbilea er st-well"'---"'F"'--:Distance from"fouridatibn"""'___..._____.Distance to nearest lot <br /> ❑ Number of pits-I_ ---Lining materia#-----------------------Size: Diameter-------- -----.--------Depth-----.--------.----------- <br /> Cesspool: Distance 'from nearest well-----------------Distance from foundation------------.-------Lining material----------------------------------- <br /> El Size: Diameter- -----------------------------------Depth_------------ ------------------------------------$Liquid Capacity-- -------------------------gals. <br /> Privy: _ ,Distance from nearest well-------------------------------------------------Distance from nearest building------..---._._..._---_-.-.-----_-----_ <br /> 171 Distance to neatest lot lire------------------ --------------- ------------------------------- --- ----------•------------------------------- ---.___----------- <br /> Remodeling and/orrepairing describel:---- <br /> -L P474-----1X.STHLL .,D--------- -.---��fSt-----_F-------------------•- <br /> J� W ---------5_-OS$4_-..-..5;_StEl�vi = ----- 3V �- i,------SA S---------5 CT -- - .. <br /> pts sR ..6,Y�Tir-M M-vs-r o t t - �3E sem- F�---- ur <br /> `JR4© - -- ----- -----------' '­­-- - <br /> hereby certify,fhat'l have preps ed-this application and that 1the>work will be done, insaccordance with San Joaquin County <br /> ordinances, ate a 's, an I and re gulafions•of-+heiSam Joaquin Local Health District. <br /> t � <br /> (Signe( --- ------ (Owner and/or Contractorl <br /> �---T';--� � .F-� --_ - -- �---- Oma'-- <br /> BY= ------------------ � (Title) <br /> �-' ! - -- <br /> Plot Ian, showing sire of lot, location of,s stem in relation fo-wellsr+buildin s etc., can be laced,on`reverse side <br /> ( P g � y Y-. 9 � P � �.•� )• <br /> "'""1"'FOR'DEPARTMENT USE fONLY�`t"�""' <br /> 41 <br /> APPLICATION ACCEPTED BY - -� ----------------�-i------------- --i------------------------ DATE----- --r 2 - �-- <br /> REVIEWED-BY----------- ------------------ - it _ 1 t >! <br /> r --------- ------ - <br /> i+i,. -iv ;n,n `;;e pre M!�rrw.-r., "'�10`"� W.# <br /> BUILDING PERMIT ISSUED --•-------------- ---------------- ----------------------------------------:,.4_Df.ATE------ M- <br /> Alterations`and/or recarrtmendations:___-____---._. �'" "'""""'" -"� ""� Rr. --- •- - -- - <br /> '- a.. .s� r- <br /> t , -� .�A, <br /> ;; - =_ ----- - ---- ---- --- --------= -- -- ------------------------------------------ ----- ------ ------------------- <br /> FINAL INSPECTI Date-------------- <�� -- - -- ----------------- ------- <br /> ---. F V h <br /> SAN JOAQUIN LOCAL'HEALTH DISTRICT" <br /> 1601 E.Hazelton Are. 300 West Oak Street ! 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.Cd. <br />, <br />