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FOR OFFICE USE: <br /> -------- --wed----------- . <br /> APPLICATION FOR SANITATION PERMIT Permit No. .A<, .. <br /> ------------------ ------ --------------------- --------- (Complefe-in Duplicate) / <br /> Date Issued --1'--- •;'- <br /> --- 10 <br /> This Permit Expires Year From Date Issued <br /> ---------------- - ----------------- 1 Y <br /> ---- <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 complian't:e with County Ordinance No. 549. <br /> JOB ADDRESS AND AjION._']_6' 0 -7 -------- - - -- --- ----- -- --- -- ----------- ------- <br /> ph _4_ <br /> Owner's Name-----------•---- ---------Z_c <br /> Address---------1-------------- ------------------- - -- ---- - ------IV---------------------- - --------------------------------------I------------------------------- --------------------- ---------- <br /> 41 . ..... <br /> Contractor's Name------.---- - - -- ------ -------- - - -------------------------- -------- <br /> Installation will serve: Re idence t Apartment House Commercial El Trailer Court E] :Mofel E] Other 0 <br /> x Q_ - It <br /> Number of living nits: Number of bedrooms _51V Number of baths­1---- Lot size ----------------------- <br /> Supply: <br /> Water I 'y: Public system El C ommunity system El Private g Depth to Wafer Ta6l;'_5V_ ft'4k _� . 1, <br /> Character of soil to a depth of 3 feet- Sand E] Gravel El Sandy Loam E] Clay Loam E] Clay El j Adobe K_,Hardpan'El <br /> Previous Application Made: (if yes,date- ) No <br /> New Construction: Yes N0FHA/VA: Yes ❑ No <br /> ...... .... % E] A. [] <br /> f TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.--_____--------Distance from foundation................._.Material ....?------------------------------------------ <br /> E]gt No. of compartlents---- --- ..--`--Size-"-------- ---------- -----------Liquid dep`h--------- ------- -----...Capacity---------------- <br /> Disposal <br /> -------Capacity----------------Disposal Field: Distance from nearest well/.0-4.7------Distance from founclatio' n__,Z9........Distance to'nearest lot line <br /> 14 Number of hnes!_ <br /> Cf,4j__ __.__Lengf� of-e;ck .*-_ Width of trench . Z4-!-------------------- <br /> % 1 .7 - - TV__-_ e <br /> of length...... ------------------------ <br /> I material----- Total <br /> Type of filter m � erial-- QQpth of filter <br /> Distance to ne��Lt 1,1�_Aqe------___-Distance om f unda,tion-- --------------- Distance to nearest lot line. .....__-.Seepage Pit: I ;9_ - <br /> Number of pifs.-I 0)-- -------Lining material. U__ Size— D i a mete r__3-3 h_-9-.57-1---------------- <br /> _5& A <br /> Cesspool: s Distance from nearest well ----------------Distance from foundation- -------------- --Lining material.-- ---------------------- <br /> S,ze: Diameter.❑ 1I ----------Depth----- -------- ------------------------------- -. Liquid Capacity----'-------.. -------------gals. <br /> Privy: Distance from nearest well--.---------------------------------------------Distance from nearest building------------------ ------------------------ <br /> Distanceto nearest lot line------------------------ ------- ­-------------- ------------------------I-------------------------- ------------------ <br /> 'I I _j ... . -------------- ---------------------------- <br /> -- -- ----- -- <br /> -- ------------------------------------------- ----- <br /> Remodeling and/or repairing (describe)-----6Zke,&.�Z------------C <br /> -------------------------------------------------------------------------------------------------------------------- ---- <br /> I <br /> ----------------------------------------------------------------------------------------- -------------- <br /> - ------------------------------------------- -....----I-----•------------I------------------------------------------------------------------------------------------------------- <br /> ---------- ------------------------------------------------------------------------- <br /> I hereby certify that prepared I pared this application'and A he work will.be done.in accordance with San Joaquin County <br /> 1 ?7 6s, <br /> 'S r ':,,P.rr d r e g u I af-m f the San Joa n Local Health District. <br /> ordinances, State law ns o <br /> (Signed)---------------------11 ------- caner and/or Contractor) <br /> -------- - - - -- -------------------- ---------- <br /> AP <br /> -- --- -- --- - -- ----- <br /> .... ... ---------------(Title)-- cl� ---- --- - .... .. <br /> By:......... ---- --- ------ <br /> (Plot plan, showing size of lot, location of system in rela on to wells, buildings, etc., can be place reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ 2e?��, el" <br /> -------- DATE----------- 77-T,- j;7------------------ <br /> ------------------ ----------------- --------------------I---------------------- <br /> REVIEWED BY--------------------------------------------- ----- ------------ --------- -------------------------------- DATE <br /> - <br /> BUILDINGPERMIT'ISSUED--------- -----t=---------------- ------------ ------------ - ---��­-72 --------------- DATE------------------------------------i--------------------- <br /> i <br /> ---------- --------------------- <br /> 7 . <br /> -7� <br /> Atte recommend - Y I--------------------------------------------------------------- <br /> '9tions:----- /7 Z(r-'j .. .... <br /> --- --------------------------I.................. <br /> -------- - ------`ry----- ------ ...... -------- <br /> n and/or reco�nmen <br /> ------------­------- ---- --- ------------------------------ -- ----- ............ ----------------- -- ---------------------------------------- ------------------- ---------- ---------- <br /> ----------------------------------­ -------- --------- ---- ----------- -------- -------- -----------------------------------------I------------------------------------------------- ---------------- <br /> f <br /> ................ ...................................._. ......... --------------I------------------------------------------------------------------------------------ ---------------------- <br /> voo_ Date---------- ------------ <br /> FINAL INJECTION BY:.---------- - -------------------------I ---------- ---- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />