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APPLICATION FOR SANITATION PERMIT Permit No., <br /> jCompl6tie ih Duplicate) <br /> Date Issued)---�__ <br /> A y <br /> T�plication is hereby made to thg San Joaquin Local Health Disf!rid for a permit to construct and install the work herein described.,, <br /> application is made in :cornplia'nce with County Ordinance NO' . 549. <br /> JOB ADDRESS AND 'LOCATION____ 1 ---------- --- ------- ---------2k%--------------------------------------------- <br /> Owner's 1 Name-----/q �16- 3 -61 <br /> ---------- 0------ --A_71._64 Phone-----A.,10-h--6--Address C --------------------------------------------------------------------------------------- <br /> ---------------- <br /> 41 0 <br /> Contractor's Name--- -------- --------:-------------------------------------------------- Phone---f----------- <br /> Installation will serve- � ResideneeE] AlIartment'House E] Commercial E] Trailer Court El Motel ❑ Other <br /> Number of livin� units: _* Number of bedrooms • Number of baths -------- Lot size ----4/_----6V <br /> Water Supply: Public'-system 0rCo'innnun-ity sy-sf'?i�i:� D- Private-R 'Depth to'Water Table f. <br /> Character of soil to a depth of-3 f Sand F] Gjavel 0 Sandy Loam Ej�01:4.y Loam Clay E] Adobe E] Hardpan Ej <br /> orf ti <br /> P*4revious Application Made: Ye; IfINo ew Construcfion-.-Yas'1�3-�o El", <br /> FHA/VA: Yes E No [I <br /> —t <br /> STYPE'OF INSTALLATION AND,.SPECIFICATIONS: rz -e Ke e f U^. ­?iA;yLy- V& <br /> (No septic tank or'cesspool.permifted if.public sewer is 6vailaible within 2001bet), <br /> nearest )14W Dis_tanc0,e' - - ----------- <br /> Septic Tank': .1 - Tfrom foundation_ <br /> Material --------- ---- ----- <br /> Distance <br /> No. .6f compartments_.,'_ ' _ 7)—_ _'L_:----:J=Siid_?_4-13_'��(3--------Liquid d&pth--- <br /> ................Capacity---g-.? -------------- <br /> % <br /> I poal �W jance from,-near nearest "T�U-6,74--Dista,6elfror-n-faund;t*ion77/6- _Distance to nearest lot'rne_,�7---------- <br /> s <br /> Nu �IInes.` Leng, ------ of trench___,.,2__y_ <br /> mIJer ot ----- ------- I­h 6,f"e�ch'line_L------jko. <br /> ------------i---- ------ <br /> type <br /> ofelfilter_�ma_fe1r—ial-f-- I- r -'---L-----DM.Vh$fif.ilf'er material_________. 3 Total length--'----/(t)------ <br /> -- <br /> ' T, <br /> - - -I -- ..........-.-.-...... <br /> SeepagePit: Drstancotcnearest well _ Distance fromfouncaflon ---- --__!_____-Distance't' nearest ]of Iine--------------- <br /> ❑ Number � __ _ Lning1mate'nal -_------Size:-----Size; D-iameter-------- ---- --- -----Depth---------------------- - ---- <br /> TT' <br /> e , A 10 o41 1 <br /> Cass _o6l: 'D-stance fi'or'nneareit,well *- ---'_Disfan-6 from foundation f-. Lining material-- ------------------------ <br /> El Size:'Diamefer------ --------I-------' Depth*__�_.r- --- <br /> Privy, Distance from-nearestweft--- --------- ---- - - - n <br /> -- --------------------------------------Liquid Capacify------------------------:---gal;. <br /> jjjt - 1----------Dista rice from nearest building_____________----------------------------- <br /> - t- -- ------ <br /> ❑ Di J�D .1 <br /> stance-to.�e'arest-,Iof:lin'e--A�------------------------------------------------------------------ -------------- --------------- <br /> ----------- ------- <br /> 1 4 <br /> peecl�Fira an. .. ..........I ....... ...... <br /> -------------- <br /> ------------- -------- --- -------- <br /> tv <br /> ---------------------------------- ------------ ----------------------------- ------------------------------- ------- ------- ------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------•------------------------------------= ------------------------------------------------------------------------------------ <br /> I-hereby:certify.that'l have-,prepa`recl Ais application and that r. 't,the e v'�o A'*will Abe clone"in accordance with San Joaquin County <br /> ordinances, State If;and rules ancl-regulafion oaqu <br /> s-of-fhe San J t4,4ocallHeAth District. <br /> -------- ------------ -------------------------------------------------------- ---------{Owner and/or Contractor) <br /> (Siined) <br /> -------91 <br /> -------------------I- -----------(Tif le --- --- --- <br /> By% <br /> (Plot pI;nj-sVqv4ng slx� oelot, lo'cation of system in"rel'a4jo'Well, %,ildi �, eidL, <br /> V jSion, "i ngs can-66 placed on reverse side). <br /> jr <br /> OR DEPARTMENT USE:-ONLY. <br /> APPLICATION'ACCEPTED BY- ff--ov <br /> - ------'-4 ------------------------------------ DAT <br /> - <br /> REVIEWED B Y,!-------t-J-------------------------------- ---'----- ---- -- <br /> --- ----------------- --- - <br /> -- --- ---------- DA ---------•------------------------------------ <br /> -------- DATE 61 <br /> BUILDING�-P_ERMIT ISSUED......... ------ -------------- 11. --------)D 1EE-------- -------A---- <br /> 4 <br /> AL <br /> ­---­-------------- <br /> Alteritions ani[/o; recommendations... <br /> _(A <br /> 0. V i k A;0 A Z. ------- T� -----X <br /> -----------­-- <br /> ------ %4A ey 4 ------ ------------------- ----------------------------------------------- <br /> ------------------------------------------------------------------- •------------------------------------------------ ------ ---------------------------- ------------------------------------------------------------- <br /> iy <br /> -------------------- ----------m4---------------------------------------- ----------------------------------­_­------------- --------------------------------------------- --------------------------------------------- <br /> FINAL PINSPECTION BY <br /> i K 16_'- -z- <br /> 11Date- <br /> C <br /> / 11 , <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT` <br /> .130 South American Street f 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi,.California Manteca, California Tracy, California <br /> ES-9-2 K4 Reviseci 1-57 RP.00. <br />