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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> - ----------------------- - ------- ----- ------------- <br /> ----------------------------------- --------------------- (CprnplefeY <br /> Duplicate) Date IssuedGrim p-------------------------------------- ThisP it,t "ires-1, ear From Date Issued <br /> i - i t -7- <br /> San Joaquin Local Health Districtif6r'a permit to construct �Iinstall the work herein described, <br /> Application is hereby made to 4 <br /> This application is madeincqm i nce'wifh County Ordinance No. 5�40 tul 7-<-6 <br /> UM3­i�q7C42;rF _; <br /> JOB ADDRESS AND'Lq"CATI'- f !LiTH RP-P--------R-P.,-.1-1-1/070-------J-1-1-IMIDEW&TE R-----I-R-R, <br /> Owner's Name----------- ITNTON-F-------------- .... Phone-------------------------------- <br /> _j� <br /> Address---------------------51�_/ <br /> lj -=M-i-- __- .11---------- <br /> ------y <br /> L9__5.*---- T ----------------------------------------------------------------------- <br /> Contractor's Name--- ------------------------------------------------------------ ----------------------------- ------------------ Phone----------------------------------- <br /> Installation will serve: Residence . Apartment House E] Commercial El Trailer CouftlEl Motel [I ,..Other 11 <br /> Number of living units: Number of bedrooms 3--- Numbe0of baths ---- Lofis�izl JM_x------AM--------------------- <br /> 1 iiltr — Aw" V% *W0 I <br /> Water Supply: Public system E3 CoC M-mull-Ity,system�R--Priva,te-2- -.-,be- h,t�Lapter S.. ft. <br /> Character of soil to a depth of 3 fee+,. Sand E��6ravel San y Iloarn 0 Clay Loam 0 Clay E] Adobe E] Hardpan [I <br /> date--------------------)� - # <br /> Previous Application Made: (If yes, No ET-_�New�__Construction: Yes E-No El FHA/VA.. Yes E] No RT� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No septic tank or cesspool pewi'miffed if public sewer is avail able.within 200 fee+:]._ <br /> Vat <br /> Set' T nk: Distance froM4 nearest ---_Distance from-foundation-_10--_-------Mater�l ---4:!ZO�V!CR F_T.F—:z----------- <br /> 0 A <br /> + <br /> No. of compartments--------2------------Size__V_X_10_X___57�__Liquid clep�h---- <br /> 'wo Y";_.7� Capacity---- <br /> Disposal Feld: Distance from nearest well--- Distance fromo,rfounVd�-'ation,---'-/.O--------Distance to nearest lot line-6------------ <br /> Er--- Number of lines___-__ ----------------Length o4ea5zhjine---95�_157.Wiclth of trench----- ...... . <br /> "f , . . -_V , - e------ <br /> Type of filter aterlwrel�o-�-K-____Depth <br /> f filfer material--- --- Total length-----------------115-70------------ <br /> Seepage Pit: Vl� nceeace from�foundatlonN_------------I----- Distance to nearest lot iine----------------- <br /> F1 Number of pits---------------- ---Uri;ng material----------.----------I <br /> Size: Diamete'r------------------ ----Depth--------------------------------_Is <br /> Cesspooli',l Distance fi-om nearest Well-r- ----------/Distancelfrom foundation--- _ -__----! <br /> oundation--- - ---- Li-iiing material__-_-.________________________-_ <br /> LAk jr 6iy <br /> Size: Diameter--------------------------------------Depth---- _,E�; ....Liquid Capacity..--------------------------gals, <br /> Privy: IDistance from nearest well--.--- 1 4- <br /> --------------------------------------------Disfanc'e from nearest building--------_---------_---___________--_-__-_. <br /> ❑ <br /> uilding------- ------ --------------------------- <br /> F1 stance to nearest lot line------- ------ ------- --- - --------- -•---------------------- ------------------------------------------------------------- <br /> Remodeling and/or repairing (describe) F=/IVC-------Z/V_'5T--, L. - <br /> fif�T THA <br /> - &-R----F-1 -a---L____�_ �- -----R_a7!40_C,6_T1-_D. <br /> ---ib-----Bu-------_5V.........F FW_M_ ------Si"GJF------- ------ ----5 ------T-,-Fk,.o--- <br /> -------------------------------------------------------------------I-------------------------------ttfl4 -------P--------------------------------------------------- --------------- ---- -------- <br /> I herebyl4erfify that I ha epakd this application and,th.0ftthejW6rk.:i4l be done in accordance with San Joaquin County <br /> ordinances, <br /> T ' '14 <br /> rdinances, afe laws, and es and ulations of the San Joaquin Local Health District. "k <br /> . .... ----------- <br /> (Signe ----- --------------------------------------------------------------------- .............. -------(Owner and/or Contractor) <br /> I k <br /> By:__---------------------------------------------------------------- <br /> ---A- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> pp X <br /> APPLICATION ACCEPTED BY------T-S. 0 ----------------------------------------------------------------- DATE----- ----------------------- <br /> REVIEWEDBY-------------------------- -------------- -- ---- ---------------------------- --------------------------------------- ------ DATE------------- ---------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------ - -------- ----------------------------------------------------- ... DATE---------------------------------- ----------------------- <br /> Alterations and/or recommendations:____':_-_-. _:_"_.'. �- <br /> - --------------- ------------------------------------------------------------------------------------------------------------- ------ <br /> . lukjsi -% �o -t r A A <br /> ------------------------------- ----- - --------------- ---------------------------- -------------------- - - - ---------- -- - -- ------------- ---------- ---------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------ ------------------------------------------------------------------------- -------------•------------------- <br /> FINAL <br /> -------------------------------- <br /> --------- -----------------�,::-------------------- ---------------------------- ----- -------------- ------- -------I ---------------- ------- -------- ----------- -------- - ---------- ----------------------------- <br /> ------------ -- ----- <br /> FINAL INSPECL, .-- wzi Date --- ---57- /�,7 4 ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.F.00. <br />