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FOR OFFICE USE: <br /> ----------------- --- ------ --- -------- ------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _ f7.------� <br /> ------ ----------------------------- -----........... (Complete-in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <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 compliance with County Ordinance No. 549. r <br /> JOB ADDRESS AND LOCATION-----L ------ o�,r�.�-----�',q_s7----5? ------.Roo.�?JQf .....©N--` h'!' -.Q. d_'4`� ir-i9_ }/z% <br /> Owner's Name---- ------ .1h�4� Phone------------------------------------ <br /> / —I -----------�;------ --- ----------------------------------- ------- <br /> Address---------------g........ t <br /> Contractor's Name------ A u--- ' ---------- ..Q' ----- --- --- - --------------------------------------------- Phone------ ---------------------------- <br /> Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: {--. Number of bedrooms .- Number of baths ..-1.... Lot size ....1.. -.X.._3.15 .._._._....-.--.--- <br /> i <br /> Water Supply: Public system ❑ Community system [I Private �' Depth to Water Table 3.,,5 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Iff Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date----_---._..____ ) No 13- New Construction: Yes No ❑ FHA/VA: Yes ❑ No W <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---S,< ..Distance from foundation------j..:k------_..Magi aIT.__-_-4..Y�". ✓ ' e <br /> 1oxG � <br /> 19 No. of compartments------------ <br /> �-----'.. Size-----•-------------- -----------Liquid depth .-. ------- Capacity---U-SO_7_09 <br /> Disposal Field: Distance from nearest well_.SI......Distance from foundation---------S------..Distance to nearest lot line-- - ---...- <br /> - <br /> Number of lines ------------ <br /> `®' n -----------Length of each lire.. ------�`._C-�.-��- --- Width of � <br /> - ----- -------- <br /> Type of filter materiai._15� ...-_...Depth of filter material----1-9-...._..-.._Total length------1.6.6.-1---------------------- <br /> Seepage Pit: Distance to nearest well_--------------------Distance from foundation__----__---------Distance to nearest lot line----------------- <br /> El Number of pits.-- ---------------.--Lining material-- ....-----.--- Size: Diameter----------------- -----Depth--------------------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation...................Lining material--___.--------------.-..____--------- <br /> ❑ _ Size; Diameter- -- -------- - --------- ----- Depth---- :---------_- ---------------------------------Liquid Capacity----------------------------gals, <br /> Privy: Distance from nearest well-----------------------------------..............Distance from nearest building----_--------------.-_-___11_11---------- <br /> ❑ Distance to nearest lot line -------------------------------- ------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-------- ------------ - - ------- - ------------------------------------------------------------ -------- ------ <br /> -------------------------------•-------------------------- --------------------- ------__----------- -------------------------------------- ------ ------------------------------ ------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) - ----------------- ---- -- - --- ------------------------------ -- <br /> g )------------------------_...--- - - -- - - - - -- - - - - (Owner and/or Contractor) <br /> By: --• --... ---- T -------- - 1111- --------- <br /> -Q ------------------ - - - ------ --- It a----- ---1111_... <br /> (Plot plan, showing size of lot, Iota#ion o -s em in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ------ - - - -------- <br /> --------------- DATE----- <br /> c --11-a <br /> REVIEWEDBY----------------- -------- --------------------- -------------- --- --- --------------------------------- ----- ------ DATE----------------------- <br /> BUILDINGPERMIT ISS ------- -- -------------------------- -------------------------------------------------------------- DATE.--- ---------------------------------------- --------------- <br /> Alterations and/or recommendations------- ----- -------------------- ----------------------------- - ------------------------------------------------- <br /> --------------------------- <br /> ------------------------------------ ------------ -- ----------- ....... ------------ ------------------------------------------------------------------ ----------------•--------- <br /> -------------- ------ ---------­...... <br /> --- ------._._....----.._..------------- - <br /> FINAL INSPECTIO .- _.--- --- Date..----- <br /> -------------------- - -- -- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.HaseEton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />