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POR OFFICE USE: <br /> ----------------- - ----- ------------------------------- <br /> APPLICATION FOR SANITATION PERMIT' Permit No. <br /> --------------------------------------------------------- <br /> ------ ------------------------------------------------------ (Complete in,Dnp icate)3JA Date Issued <br /> --------------- --------------------------- --------- <br /> Applic*artion isrhereby,mA6o-ttie_-,San Joaquin Local Health District for a-permit to construct and install the work herein described. <br /> This application is made in,-compliahce with County Ordinance No. 549. <br /> AND �OCAT&-___ .�*--- - --------- <br /> -JOB_ADDRES�'A' ------ ---- ----- <br /> I . --------------- ---- ----- -------------------------------------- <br /> Owner's Name------------%joHiq_.-A. ------FRE,---------------------------------------- -------------------------------------------- 9Pone------------------------------------ <br /> Address------- <br /> iA---------t3............. ------------------------------------------------------------------------------------- <br /> 4 <br /> -------------------------------------------------------- ----------------------------------- <br /> Con r r AIE ------------------- Phone.------f cit Name----t�;O. <br /> Installation wiIf.'se'rv8`:nZdehc Apartment House ❑ Commercial E] Trailer Court C] Motel E3 Other C] <br /> Num&er"6f,li�A, lei �o )19 <br /> Number of be� oms Number" of baths ----/__ Lot size ----A- ----- -----------_---------- <br /> Water!Supply: Public y_Sierf;. 0 C6mmunity�sy (�m [] private E], Depth to Water Table:�!o ft. <br /> 4-sdharattobf soil to a�depfVi3f'g feet: Sal-d ;rcG-ravel S dy Loam [] Clay Loam E]/Clay El Adobe El Hardpan <br /> a ❑ <br /> P <br /> reyrous Application. Made: (I •y.e�s,date--- -----------------i­ 'N6 New Construction, Yes No E]_ FHA/VA: YeI_E] No <br /> S <br /> TYP.E,OF INSTALLATION AND SPECIFICATIONS: <br /> '09(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> -----Distance f --------------- ----- <br /> f'r <br /> SepfiEIT Distance from nearest well- from-foundation_h2--------Mate lal-JEONC-R ------------ <br /> No. of compartments---------*�Z ---------Sie_.5.XT_)(_5__..Liq,id depth--------- -------_____-_Capacity.... <br /> .!2 7....... <br /> Disrosdl,,Fielcl: Distance from nearest well--,5 -----Distance from foundation---/0.........Distance to nearest lot line-_5....... �j <br /> A <br /> Nu�nber of lines-.&.. Length of each line-5-1-Y jtl::;•�Width of trench---------36.1#------------­-- <br /> 'I <br /> ------Total <br /> -- . length-------)VIOL",------------------- <br /> Type of filter maferial-6---RQC�_/'�__Depth of filter material----- <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation--------------r___.Distance to nearest lot line---------------- <br /> Eli Number of pits----------------------Lining material-----------------_-----Size: Diameter---------------- ---Dept k--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----_-----_------..Lining material__.---_----.-_,------.----- -------- <br /> F-1 Size: Diameter--------------------- --------------- Depth----------------------------------------------------Liquid Capacity............._ '--gals. <br /> Privy: Distance from nearest well------ ------------------------------------------Distance from nearest building---.----.------._-----_-.-_--_--_-_------. <br /> ❑ Distance <br /> uilding--- -------__-------------------------- <br /> Distanceto nearest lot line.- ----------------------------------- ------=-------------------•--•-•---•---------------------------------------------------------:----- --- <br /> Remodeling and/or repairing (describe):--- ---------------------------------------------------------------------------._.....-----•-•---------------•-•------------•---------------- ------ <br /> ---------- ----------------------------------------------------------------------------------­----I------------------------------------------------------------------------------------ ------------------------------------ <br /> ----------------------------------------r---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- <br /> ---------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- <br /> 11hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, S Pfe laws,/and rules and regulations of the San Joaquin Local Health District. <br /> —.(Signed)---- W, X -- <br /> ------------------ ------------- ------------------ ---------------------(Owner-:and/or-Contractor.l- <br /> :-------- --------------- ------(Title)----------------------------------------- -- ----------------- <br /> W------------------- ---------------------------------------------------------------------------- <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 /> APPLICATION ACCEPTED BY--------- ----------------------- --------------------------------- DATE---------• --------------------- <br /> REVIEWEDBY-------------------------------------------------I------------------- ----------------------11 -- .-----_-- DATE----------------- ------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------- �------------------------------- DATE------------------------------------------------------------ <br /> Alterations-6,ad -------------------------------------------------- ------I---------­------------------%---------------­ -------------- <br /> ,�,6i�r�gc'orn mendat ions-------------- -- ---- <br /> W. <br /> *61]-------VF__N.'7------- - -------F----DP <br /> _7!1i -CEVIF;tp---- ------------------------------- -------------------------- <br /> ------------ 'N <br /> #1----------- ------------ ----------------- ------ --------------------------- -------------------------------------------------------------------------------------------------------------------------------- <br /> -- ------ ------------------------------------------------------------------------- -- -------------------------------- <br /> .... ... - ------ <br /> ............ <br /> . -i ----------------- ------- - ---------------- <br /> ------------------------------------ ------ -------- . .................. ----- - - ------ - --------------------------------------------------------------------­­------ ------------------------------- <br /> X1 4 <br /> Fl NALL:_INSP -- -- ---- Date--------j?-749P ------------- <br /> D --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American.Street 300 West Oak Street y 124 Sycamore Street 205 West 91h Street <br /> Stockton,Califorala.1 Lodi,Californip, Manteca,California Tracy,California <br /> EB-9 REV4SED 19-59 r.0,00,7M'6-601 <br />