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APPLICti ATION FOR SANITATION PERMIT Permit ------ <br /> I (complete in Duplicate) Date Issu8j/�_/v-, <br /> )eApis <br /> afikon is hereby made to the Sanijoaqu.in Local Health District for a permit to construct and ;nta;j the work herein described. <br /> This application is made in compliance.with County Ordinance No. 549, <br /> --- ------------------------------------------ <br /> CATION..j� <br /> JOB ADDRESS AND LO -------------------------------------- Phone---7!!7�--------------------------- <br /> bym_a. ___6 -------- ---- -- -------- <br /> Owner's Name-----------------I------------------- ------------------------ <br /> -1------5'. 1•------------ ---------- ------11------------------------------------------------------------I—— 1F <br /> Address-------------------------------------- ------------------------------------------------------------ Phone---g-,4-P-7------- <br /> Contractor's Name____________________________Re s i den c e $ Apartment House [I Commercial [] Trailer Court 0 Motel [3 Other E) <br /> Installation will serve: bedrooms ----- Number Debth <br /> s -VJateoTa`ble <br /> ..Number of living units- --I--- Number of bedr Private [] pto it, <br /> Water Supply: Public system. W( Community systemClay Loam [I Clay [] AdobeX] Hardpan (:] <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel ❑El Sandy Loam 0 <br /> Previous Application Made: Yes D No A, New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- <br /> foundation_ ..........Material---6� '_ - -------------- <br /> .are�t weIJq0A_ff-D istance rorp <br /> Septic Tank: Distance from nearest 11j- j ---Liquid dep*_!$_.V1-----------------Capacity <br /> No. oi,c-ornpartments-'-p------------.. ....Size-, -A <br /> 157VfroCmx� dation____________________Distance r-------------Distance to nearest lot line__---__-_.._.__. <br /> V_ Distance from nearest well------- ----------Distance Width of french----------- ----------------------- <br /> Disposal Field: Nu.m6er of lines---------------- --:---------------Length of each line------------------------------ <br /> Tyleor filter material-------------------------Depth of filter material----------------- -----Total length---------------------------- <br /> I foundation_&��_7�------Distance to nearest lot line____.._____.... <br /> Seepage Pit Distance to nearest well-.40-t-AA------Distance fr9,rn 4 --------------------- <br /> D V er-13" Depth--, gp, <br /> Number of piis-­_L__-----------Lining material&t& j-- <br /> Size: Diamet ------- <br /> ADistance from foundation---------------------Lining material------------------------------------- <br /> Cesspool: Distance from nkearest Well— -.LjqL�i3OCapac.ifyj--- ------------------- --gals. <br /> Sizes:_Diameter__ ------------------------,==,:,.-,,,-'Depth-------- <br /> 0 �i;o;� —_ � — Distance from nearest building------------------------------ --------- <br /> Privy: Distance from nearest well----------------------- ------------------ --------------------------------------- ----------------------------- <br /> Privy: <br /> to nen-rest lot line-----------------­-------------------------------- <br /> D -------------------------------- ----------------------------------------------------- <br /> Remodeling and/or repairing (describe):__--------------------------------------------- ----------- ------------ ---------------------------------------------------•-------------------------------------- ----------------------- 7- .... <br /> ------------------------------------------------- ---------------------------------------------- -- ------------------------------------------------------------­ <br /> ----------- ----- -I-------------------------- --------------I----------------------------- ----------------- <br /> ------- <br /> --------------- ----------------- --------------- ------------------- ------------------------------------------- <br /> ----------------------------------- ---------------------------- ------------------------------------------------ accordance with San Joaquin County <br /> ------ at I have p ed this application and that the work will be done in <br /> I hereby ce i r uin Local Health District. <br /> that pre <br /> of the San Joaquin <br /> Stat 5, an <br /> ordinances, St't =a' rules Cont�racj_f ) <br /> -------;4,c---------------- - ---- -------- ---------- - ----- -- <br /> a ' r------------------------------ 4pdoL <br /> (Signed)------------- ------------------------(Tal 77 <br /> -j�- on re <br /> ------------------------- ed reve so side]. <br /> -------------------------------------- to buildings,I etc., can be <br /> By:. size of lot, iocatilon of system Irelation I ildings <br /> (plot plan. showing �7.- u <br /> rl <br /> FOR DEPARTMENT USE ONLY <br /> _8------------------------------- DATE---------- -- ------------------- <br /> - ------------------- <br /> APPLICATION ACCEPTED BY---- -----------i�----------- -------------------------- ----------- DATE------ -- --- <br /> --------/---------- <br /> REVIEWEDBY-------•----------------------- ------------------------------------------------------- ------------------- DATE------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------- <br /> ---- ----------------------------------------------------------------I---------------------------------------------------------------------------------------- <br /> ------------------------ ------- <br /> Alterations and/or recommendations----------------------- -- <br /> ­------------------------------------------- <br /> ------------ --_------------ ---I------------------ ---------------------------------------------------------- --------------------------------__--------------------I---------------------------------- <br /> -------I----I-------------1---------------------------- ----------- ----------------------- ----I--------- -------------------------------------------------------- <br /> ----------------------------- j-------- --------------------------------------------------------------------- -------------- ----------- --------------------------------------- <br /> ---------------------------------------- ----- ------------------ <br /> ----------------- <br /> -------------------------------------- ----- -------- ---------------- <br /> Date_.. ----- ... .. --- -------- ----------------------------- - <br /> FINAL INSPECTION BY:_..____"-_ --- - --------- - ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT $14 North "C" Street <br /> 132 Sycamore Street <br /> 300 West Oak Street Tracy, California <br /> 130 south American Street Lodi, California Manteca, California <br /> Stockton, California <br /> rq-9-2M [0-52 Revised W-21OO <br />