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FOR OFFICE USE: <br /> ------------------:--- --------------------------------- <br /> ----------------------- --- --- ------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------------------- -------------------- 71 <br /> (Complete in Duplicate) <br /> z1 _q <br /> ------------------------ --- ---I------------------- This'Permit Expires 1 Year From Date Issued Date Issued ' <br /> Application is hereby mad6'to the Santoaquin Local-Health District for a permit to construct and install the work her described. <br /> with County Ordinance Ncl, 549. C. <br /> This application is made in compliance wi eq C5- b L(O,- I IRI <br /> JOB ADDRESSAND )C-6TjON d - ----- -------- <br /> -------------- ------ ------- -- ---- <br /> Owner's Name-- --- <br /> ... ... ------- --- -------- i one_ <br /> ------------------------A <br /> ----­--------- <br /> - <br /> Address-- ----oZ-! ---------- --- - ------------------------ - ---------- - ------- -- --------- -----------------------•---------------------- <br /> C. <br /> C <br /> Contractor's <br /> ----------------------------------:---------Contractor's Name,- ------------- Phone----------------------------------- <br /> Installation will serve: Residencep arfmen House El Commercial E] Trailer:Court E] Motel ❑ Other [I <br /> units: Number of be, Number o_f-baths _'!Lpt' <br /> Number of living uni. bedrooms size ------- ------- <br /> Wafer Supply: PublicCommmunity system Ellir-i. q10*`D th f "Waf'r Table --------- ff. , <br /> syst6m El, vote- U —.ep. _�y,,,,e <br /> v <br /> Character of soil to a depth-of 3 feet:45-and"❑Gravel ❑ S y cam Tr Clay Loam [] Cl E] Adobe[] Hardpan F <br /> 1-1 Ej IXC .. . <br /> Previous Application Made: (If yes,date------- -Not New Construction:Yes ��/No OEY] FHA/VA: Yes El No 2__� <br /> TYPE..OF INSTALLATION ;AND SPECIFICATIONS:- <br /> (No septic tank or cesspool permitted if public sewer iSraVa lable ivithio 20 46. <br /> 7 frpm fouidatio ----- ------------ <br /> -'SrpfiC'__T "'k:-- 01's_fjnce f -----------------Disfanc <br /> lk �An` No. of !comparfme�45...... _.Size.__ V_6__.,rALi`quid de0h------)/...... ---------Capacity.../iap ak, <br /> DisposField: Distance from nearest-well----- -0.--.Distance from foundation_____P,0___-!__.Distance to nearest lot line_--IS- IT <br /> 0 -------.Wiclth of trench.__ =2 ------____ <br /> --- <br /> Numbe� of lines. Length of each Ii <br /> I---- ------i----------Total lem ----------------------- <br /> Type of filter material-_,e -Dekpthlof filter material____ ___ gth--- CIR <br /> t <br /> Seepage Pit: Distance to nearest well------- -----—_-Dit-Itan(fe from foundation------- ......Distance to nearest lot line----------------- <br /> r------------ Depth_---- <br /> El Number of pits----•-------------- Lining material_,------- '-}---.� -------Size: Diameter______.____ <br /> ------------ ------------------------- <br /> J. from foundation--------------------Lining material____-_._._:____,____________"_ <br /> Cesspool: D;sfan from ------- <br /> c:e <br /> El Size: Diameter--------F-----------------------------'.Depfh!------------------------------------ --------------Liquid Capacity----------------------------gals. <br /> N <br /> Privy: DisfanJe from nearest well---------------- --- ---- ------------------Distance,fro' m.'nearesf building------------------------------------------- <br /> I - ".1 ��!� 3; <br /> ❑ Distance to nearest lot lisle.-------------- ----LA " n-77 �' J�---------------- ---------------------------------------------------------------------- <br /> . <br /> -------------------- <br /> V <br /> Remodeling and/or repairi'ng (describe):----------------- ---------------- <br /> -------------------------------------------- ---------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> • <br /> ------------------------------ ------ ----------- <br /> --------------I-------------------------------- <br /> ---------------------------------------------------------w----------------------------------------------- <br /> ___------- i -------------1 <br /> --------------------------------------------------------- -------------------- -------­---------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I�have prepared this application and that the'Work will be done in accordance with San Joaquin County <br /> ordinances, State laws,�a rules and r-egulafioni`of..fhe-SanAociquin Lq'cal..Health District,. <br /> -------- --- ---- <br /> (Signed)---------------- -------- ---- - -------- ---- ------------------------------------� ---------------------------------------J0wrn!r:snd/or Contractor) <br /> _ftm_� �4, <br /> . .......... J. <br /> ------------------------(Title)------------- <br /> -------- ----------------By: <br /> - ------- -7---- ------ <br /> L <br /> (Plot plan, showing size of lot, location of sys e in relation fc0ae s,'bullldings, ife., can.6e' .placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> .0011 -11, <br /> APPLICATION ACCEPTED BY____ - DATE------------------------------------------------------ -Y ------------------------------ <br /> 37- <br /> - <br /> REVIEWEDBY--------------------- --------------------------------------------------------------------------------------------------------- DATE-------------------------- --- ------------------------ - <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------- <br /> Alterations <br /> ATE--------------------Alterations and/or recomm'endafions:------------------------------------------------ --------------------------------------------------------------------------------------------------------- <br /> ----- ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------- --_------------I- - ---------- --- ------------------------------------------------------------------:----------------*------------------------------------------------- <br /> --------------------------------------------------------- ------- -------- ---------------------------------------------------------- ----------I--------------------------------------------------------------- <br /> ---------------------------------------------- ------­----------- ......... -------------------------------------------------------------------------------------- ------ -------------------------­-- <br /> FINAL INSPECTION BY ----- <br /> ............--- Date--- --- --------------------------------- ................ <br /> - - - ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoseltort Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 3M 3`6311F.P.120. <br />