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FOR OFFICE USE: '~ <br /> {APPLICATION FOR SANITATION PERMIT Permit No.-- ------•----------------- ---------- <br /> _..rz� .... <br /> --------------------------•------------------ I / <br /> ' �Complete•in Duplicate} <br /> __ Date Issued_-_._.___.-_ . __..__ This Permit Ex fres 1 Year From Date Issued <br /> Application 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 County Ordinance No. 549, <br /> JOB ADDRESS AND OCATION---{----- - -7 s/</ .....e r--------- <br /> Owner's Name'' <br /> oAddress------------------- <br /> Contractor's <br /> - <br /> Name------.---- ------ °" �.C .'.._f�{• Phone. a • .� d[ •t,.: <br /> In-stallation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Traitler- 4=V Motel Other ❑ .. <br /> Number of living units: __ ___ Number of bedrooms vL_ Number oT baths _/--- Lot size ... ____________________--__"" \v <br /> r <br /> Water Supply: Public system E] Community system Q Private FV Depth to Water Table, _ ft ` <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ \� ^V} <br /> Previous Application Made: Jif yes,date- -- --- ] No X New Construction: Yes W No ❑ FHA/VA: Yes ❑ No 1�r 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Y" <br /> (No <br /> septic tank or cesspool permitted if public sewer is available within 240 feet.) <br /> Septic Tank: ce <br /> - compartments <br /> from nearest we_l.l_. - ."/." Distanc. <br /> e from founda-t-ion_.. 0..r----..Material __. --------------------------- <br /> No. <br /> ---..__"......_...._. <br /> .... <br /> No. of com artments_..___ -----�--Size_ � Liquld deph----J�- -- -----.Capacify--j d6_ <br /> Disposal Field: Distance from nearesf well_....."Distance from foundation_ 0-__."_ Distance to nearest lot line------s_ ._.. <br /> A <br /> Number of lines....... _/.. Length of each,line_.._ _p_ __. � � � <br /> ! --- g lam.:-- � ...Width of trench � "--•----------------�- <br /> Type of filter material._ "---"_Depth of filter material_--- - __..Total length........�Gl- ------ <br /> Seepage Pit: Distance to nearest well_lQfJ_-f-_"Distance fr m f undation___/"Q-7__".Distance to nearest lot line--.-- ---------- <br /> Number of pits_.. <br /> -------- -------Lining material-, _ ---"--- Size. Di6meter"__;7- .yr----Dept h__"C75"__-f <br /> Cesspool: Distance from nearest well ----------------Distance from foundation....'------------ lining material-----_.-"--._..--___._._______----- <br /> ❑ Size: Diameter- -------- ----- ------- -."Depth--------------------- ------- ---- ' ----- -- --Liquid Copacify ---- gals. <br /> Privy: Distance from nearest well------'±____ ....................Distance from nearest building"____..""-__.____-.____"_--_..______._. <br /> ❑ .t .t 4 :.ti t ' <br /> Distance to nearas{'t lot line - -- ----------------- ---------- ------------•----------------------------- - ------------------------- <br /> m <br /> •----------------------- <br /> R modeling and/or re airing [descriiJe):____ _._______ <br /> f t ( 0-1-- --�-�--- <---------- <br /> E <br /> (rr 4- "t- � --- 1=/ - -.:-- tri .5' � _ . <br /> - <br /> /16�-r-rfta --- S ---- - ------ 1 -------,� <br /> /fir { - > ------- -- ., - --- � �. --� <br /> _f l , / a <br /> I hereby e tify that I have prepared this application and that the work will be done in accordance with San Joaquin County _ <br /> ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_ (OwnerrContractor) <br /> � 4 <br /> 1 <br /> ------------------ <br /> i <br /> By:.- ay Qom. �y ='--------- - r Title}' <br /> --- . ............. <br /> (Plot plan, showing size of lot, I atioi,of sy m in relation to wells' buildings, etc., can-be placed on reverse side). <br /> DEPARTMENT USE ONLY ; <br /> APPLICATION ACCEPTED,BY---..— - DATE_ Y-.�f_.. - <br /> REVIEWED BY - -------------------- .--------- -------------------------- DATE--------------- J <br /> BUILDING PERMIT ISSUED______ [ <br /> -- -------------------------------------------------- <br /> --- -- -------------- ------ -----------=--- --- ------------',"}------._ DATE-- -------------- --- - --- - -------- - - <br /> Alterations and/or recommen ations_________________________W-,-- <br /> ­1 <br /> e <br /> S..r {.f.-- -_.--"--- W�, <br /> -------•--------••------------- <br /> - ----------------------------------------------------- <br /> ----------- r /�( <br /> ---------- - <br /> T- <br /> -- - ---------------------- ------------- <br /> /'—% "6�r env 4�r%rte ` ccv�r� 1fiv <br /> FINAL INSPECT ON BY:------------ Date--- r<. -. <br /> W. . / .......... ------------------- <br /> do_ *, � b <br /> A UIN''LOCACHEALTH DISTRICT # <br /> 1401 E.Hazelton Ave. t 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> E <br />