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4. <br /> Permit No. <br /> APPLICATION FOR- SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Date ISSU67d_.___!_F°/rk_ <br /> Alicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with CourOrdinanct No. 5�9. <br /> JOB ADDRESS &= 7_,'LOG, TI 4 <br /> n ------------------------------------------ <br /> Owner's Name--- -TA-------- ------------- ------------- Phoria o rie <br /> I-------------- - ---------------I---------------------------- ... <br /> Address------------ -------1 V a , , 6 r <br /> ----------------- ---------------------- JY- <br /> ;------I-------- ----A-------------------------------------------------- <br /> Contractor's Name--.&-Zl---- ---•------• ---------------------- 'e'—' Phone..?, -"-*------------------------- ---------------------------------- --------- <br /> Installation will serve: 7R7d_en_crr, Apartment House 0 Commercial Court E] Motel El OtherE] <br /> Number of-living units: 1_ umber of bedrooms __-Z Number of baths --- Lot size <br /> ----------------------- ------ <br /> Water Supply. 'Public system' Community system [:1 Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam ❑ Clay Loam Ej Clay E] <br /> i El i I Adobe E�j- Hardpan E] <br /> Previous Application Made: Yes E] No ;;�ONew Construction. Yes ER"'No 0 PHA/VA: Yes E] No ER--� <br /> -TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic fanOr'cesspool permitted if ublic sq�ver is available within 200 feet) <br /> T - - ----------- <br /> I <br /> Se tank: Distance from nearest well41Distaa__cp i io,) <br /> No, jof compart cef f_oT fo -------------3�------ <br /> ments------- ------------Size- --------Li�uid deptb --------------- a -- V <br /> i'al <br /> C ...... <br /> Dispos Field DistYn-ce-fr-o-m*-neare�;f-welilt--.1�---�-Distance-frcim"-4oundat4oni/o��Distance to nearest lot line e-11D <br /> Number of lines---------- 2� -------Length of each line--------ZGj 40,/4170.Width of tr;nch ---------- <br /> Type of filter maferigk?0(,�*4bepfh of filter material--------L9--___,Total lengfh!----------------L6Vt___-____Seepage Pit: Distance fo nearest'­We,ll___"- ------Distance from foundation-------------­------Distance to nearest lot line___________-.___ <br /> ❑ Number of pits----------------------Lining maferial--------------------------Size: Diameter-----------------------Depth---.---: 1. n <br /> Cesspool: Di:stance from nearest fouQ*F*io-n­'—L� <br /> -----Lining'Cndf6rial------------------------------------------- <br /> ❑ Sze: ame <br /> iDiter-! / <br /> -------&--------------------Depfn--------;-- %-------:---- ------# <br /> ------------------------Liquid (�a_PacitY----------------------------gals. <br /> a.. A <br /> Privy: Disfance.from nearest weEl--------------------- <br /> ----------- ------r--------Distance from nearest building_-________.______________ <br /> Distance-to nearest 4of line_ ---------------------------- <br /> V --------------------------------------- - --------------- <br /> Remod&n4nd'/or repairing jring <br /> JI <br /> e�bribe�:----------------- <br /> --------- ------------------ <br /> -------------------------------- -------------------------------------------------------- <br /> ---% ----- - ----------------------- I-------------------- --- --------- ---------------------------- -- ----------- ------------------------------------------------- <br /> ------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------I---------------_----------- <br /> ---------------------------------t-----------------------I------------------------------------------------------------- <br /> -----------------------------6---------------------------------- ------------------------------------ <br /> I hereby certify that I have prepared this application and that the work w'ill-be,don-'e'in accordance-with San Joaquin County <br /> ordinances, State law and Ile a d regulations of, the San Joaquin Local Health District. <br /> . ........... <br /> ......... .. <br /> (Signed) -- ------- - ----------------------------------------------- -------------------- ------------(Owner and/or Contractor) <br /> By:-------- -------------------------------- ------ <br /> -------- ---------------------------- ---------------------------`--I---------------(Title) ------------------- ---------------- <br /> J <br /> (Plot plan, showing size of lot, 16cati6n of system in relation to wells, buildings,!,etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY 11--- --------------------------------1----------------------------------------------- DATEqZ-_ <br /> - <br /> -------------------------------------------------- <br /> REVIEWED BY---- --------- - _�_Z 11� <br /> - -------- --------------------------------------------------------------------------- DATE <br /> -------------- ------- ------------------------------------------ <br /> BUILDING PERMIT ISSUED---- ------------ ----------- ---------------- DATE------CiA------ ----------------------------------------- <br /> Alterations and/or recommendations- j - <br /> --------------------------­-------- <br /> --------------- <br /> -------------------------------------------I------*------------------- <br /> .............. <br /> ems- <br /> ---------------- -------- -------------------------- --------------------------- ------- <br /> ------------------------------------------ ---- --------------------------------- <br /> 4,� <br /> FINAL INSP�/ TIO- N BY:-----:—---------------------- -------------------------------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES--4-2M Revised 1-57 F.P.CO, <br />