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F4)R-GFAICE USE: <br /> ss <br /> APPLICATION' FOR; SANITATION PERMIT Permit No. <br /> ------ ------------------------------------------------ <br /> --------------------------------------- -- --- --- (Complete in Duplicate) <br /> ------------------------- ------------ ---- ............ This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w0rk herein described. <br /> ppp iccqion is made in compliance with County Ordinance No. 549. 0rC-A <br /> This Ii Z616� <br /> goo 4 2- r S2 <br /> "4') A L`5 11)r 50 r- <br /> JOB ADDRESS _CATi0N_JN_1_QtJ-------R-0----------7 ........ ... -------- ------- <br /> ----------------- -- ---- -------- Phone-.--_--------------­ ------------- <br /> Owner's Name_________ Awuu---- F----------H&Rrm-4r�D!�R <br /> ------------------------- <br /> Address----------R_a�t.... ---------4A.TN_F?0_ ---------------------------------------------------- <br /> 7- 7 <br /> Contractor's Name____,_49A#JMR-----------M..... -------------------------------------- Phone--------___---------------------- <br /> Installation will serve: Residence fT-ApartmentHouse E] Commercial E] Trailer Court El Motel F] Other E] <br /> Number of living units: Number of-bedrooms 3__ Number of baths I--- Lot size ---i4 11 <br /> Water Supply: Public system E] Con6unity system [_1 Private.Depth to Water Table 1-0 ft. <br /> Character of soil to a depth of 3 feet: Sand 12,1 Gravel E] Sandy_Loam-E] - Clay,Loam [] Clay E] Adobe[] Hardpan C] <br /> Previous Application Made: (If yes,date__,, -,---_--------) No � New Construction: Yes El No Zr"*FHA/VA: Yes D No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br />--(NF-se—ptiE-fa-nk—or-ce-ss—po-ol--p-er—mitt6d-if-�u-15-lic sewer.isevadablewt*;ii-n:-Zi0-d--:f <br /> Septic Tank: Distance from nearest well---%50 _Distance from foundion---- .......materiaR------DWO-04>0------------- <br /> No. of compartments-----72—----------.__Size_3__X1__X_ .__Liquid depth----- Capacity..... <br /> Disposal Field: Distance from nearest well- 540....Distance from foundation_-___/_0......Distance to nearest lot <br /> Ir 7,f'.#f -- <br /> Number , <br /> of lines---------/-----------------------Length of ea'cV_hne___-5__ ---_Width of trench.......A_5?----------------f. <br /> I <br /> Type of filter Depth of filter mater�at__ length---------- --------- ----150-------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line--_.__-__--___.__ <br /> ❑ <br /> ine---------------- <br /> F-1 Number o� pifs�--------- -----------Lining material---------- -----------Size: Diameter-----------------------Depth------------------------ <br /> Cesspool: Distance from nearest well_________________Distance from foundation._.__._._.-.__ .._Lining material_.-.__.._----------- --------------- <br /> Size: Diameter------------------------------ ------ -----_..._____..Li quid Capacity---------------------------- <br /> Privy- .Distance from nearest -------------------------------D"istance from nearest building----------------------------11........ <br /> ElDistance to nearest lot line-. r -=-------------- ------ ---------I-------------------------L----------------------------------I---------- ------------ <br /> Remodeling and/or r'@pair;An describe):_______.. :-` <br /> jh---------------- ------------------------------------------------------------------------ -------- <br /> 5y_ __S77__1EM-- --- <br /> - --------------------------------------------------------------------- <br /> ---------------------------------T ----PAIR----JE)0_�5__r ---h <br /> ------------------------------------------------- ------ ---- <br /> - ------------------------------------------------------------------ ---------------------------------------- -------- <br /> ------- ---------------1------------- <br /> ------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that F4 have prepared this application and that the work-will be done in accordance with San Joaquin County <br /> i-ordinances f to laws, .an8 a eg n -af the San Joaquin Local Health'Disfrict. <br /> P <br /> ------------I----------------(Owner and/or Contractor <br /> (Signe4)_1­­ ---------- ----- ---- ------- - ----- ----------- -- - ---- -- --------------- ------------------------------------ <br /> ------------ ------ ---------- -- -- ----------- -------------- -------------- --------------- <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 /> APPLICATIONACCEPTED BY --------------------------------------------------------------------- DATr=------ �r------------------------ <br /> REVIEWEDBY------------ ------------------------ ----------------------------------------I-------------------------r------------- :_-- DATE--- ----------- --------------------------- <br /> BUILDINGPERMIT ISSUED------------- -------------------------------------------- ----------------I - -, DATE---------------------------------- --------------------------- 11 :------------- ------------- <br /> Alterations and/or recommendafioni---------------I----------------------------------- ------------------------------------------------------------------------------------------------------------ <br /> 5-7., -A <br /> -------------- ------- A)-fS------Tf4_(.S------ -e-7- -- --- ------- ----As <br /> 14 <br /> SHOWe J_n.47�-----com P ------FF om------- N_............./my.......H_A_Vf��--- <br /> -A-------By <br /> 'ac . . ........amnolr4------By. ---------�5_Tl-; ---OF PA.:ffT&S ....CP-, <br /> ------------ <br /> - -------------- 0_^1---- ------------- <br /> F 11-01,16P <br /> 1`0 <br /> INSPECTION BY:... Date_ ------------------------------------------------------------ ------- <br /> FINAL INSPEC --------------- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave. s 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />