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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------ - ----- ---- ------------- ------------- <br /> ------- -- --- --- ------ ------------ --------- (Complete-in Duplicate) - <br /> 17 <br /> This <br /> - -- ----- --------------- ------ ---- <br /> This Permit Expires 1 Year From Date Issued Date Issued ._�--'.__-_- - <br /> } a' <br /> Application is hereby mato fhean SJoaqu <br /> de in Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliande with County Ordinance No. 549. <br /> JOB ADDRESS AN OCATIO ---- f 7` ------ _e�0'777- ---5------------------------------------------------------------------------------------ <br /> Owner's Name----- - ----- - - ---------•�----- - �„�f�g'�--- ------ --- - ------- ----------- <br /> ------ --------- Phone------------------------------------ <br /> Address---------------�-SQL'fJ r--------'-------------------=------------------------------------------- ------------------------------------------- -----------------------------------•- <br /> Contractor's Name------ --•---- d - � --- -- - Phone. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer-Court ZK_M�otel ❑ Other ❑ <br /> Number of living units: n­r Number of bedrooms %.$— Number of baths.%4— Lot size a . Z_U/Q..__----_-------------_ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table O(ft <br /> Character of soil to a depth of 3 feet- Sand ❑; Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe [�ardpan ❑ <br /> Previous Application Made: (If yes,date-...__..._.�_____.. ) No [; `New Construction: Yes E] No 'FHA/VA: Yes E] No •- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> _ P <br /> Septic lank: Distance from nearest well____--fir"_.__Distance from foundation-_,/Q_._____.Materiaj1.0Z,7o-;feA1P$�e7......... <br /> No. of compartments__. ________________ depth_ , ----- _.__.-._CapacityQQ____ <br /> Disposal.Field: Distance from nearest well............Distance from foundation__-_—___.___.Distance to nearest lot line__ <br /> ----------- <br /> [Zy�' Number of lines -_.. ..._. Length of each line_,AQQ-*-.�__---_.Width of trench-r2_.'_`__.._-___-...___...- <br /> T e of filter materia __ <br /> yp V, _.__Depth of filter material__ .__.________Total length__Z.fl _ _______________________ <br /> Seepage Pit: Distance to nearest well._.__.__-----------Distance from fo ndafion_/Q.______-Distance to nearest lot line.._tr - .._ <br /> Zj--r S Number of pifs.__A-------------Lining material,/CA?z . Size: Diameter._,. ` --------Deptn_v?.+�------------------- <br /> Cesspool: Distance from nearest well _--___-_-__.__Distance from foundation................. ..Lining material_._.___-_-________________.____.---. G <br /> ❑ Size: Diameter- -- -------------- ----- ----------Depth--------- - -- - -------------- --- ----------------Liquid Capacity- --------------------------gals. <br /> Privy: f Distance from nearest well-------------------------------------------------Distance from nearest building-------_--.-.__.-_-_-________..___....._. <br /> ❑ Distance to nearest lot line - - ----- ----- -- -------------- ------------------------------------------- ------------- -------------------------------------------- <br /> Remodeling and/or repairing (describe):_... Pte7W5 �___.5r ax f __, ' w�', Gr�,j 7.__--- <br /> ------------- `7.......... ---------- ------------ _ ------ <br /> ------- -- <br /> ---------- ----------------- -------------- ----------------------------------------------------------- -------------------------------------------------------------------------------------------- --------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count-- <br /> ordinances, State laws, and rules and regulafiions of the San Joaquin Local Health District. <br /> (Signed)-------------------------/ /fi' ��6/e --- --- /---- -------------------------- ---(�r Contractor) l <br /> By:------- -'-----------;' elation <br /> `%�' (Title) -~� - - <br /> (Plot plan, showing size of lot, location of system to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ___ _ ------ ..... ................. DATE____/_-�_�-/ --. -...._.___•- .- <br /> ------------------------------------- <br /> - ------------- <br /> REVIEWEDBY--------------------------------------------- ------------------------------------------ DATE----------- ---- -•---------------------------------------- <br /> BUILDING PERMIT ISSUED---`---- -- ------ l--------------------- ------------------••--------------------------------------- DATE------ -------------------- <br /> Alterations and/or recommehdations:---- -------------------------------- ------------------------------------------------------------------------------------ <br /> --------------------- <br /> i <br /> ------------------------- ------ ------------------------------------------------------------------- ----------------------------------------------------- ------------------------------------------------- <br /> F_ <br /> -----------_----------_-----------------------------------.--------__.__._._._.---___._._...._--__-._._-..-..-.-_--..._..-_---__ _._._.__-----_._....-___-.__._._____._.-_---__._..._- ___ ---------------------------- <br /> FINAL. INSPECTION BYIrV----. Date._...1!SAN JOAQUICAL HEALTH DISTRICT <br /> 1607 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> Stockton,California ,t Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />