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FOR ctFFICe USE: j <br /> Permit No. ..1..1__2 •� <br /> APPLICATION FOR SANITATION PERMIT <br /> -----------------------------------------------"'` ' <br /> .._ �� (Complete in Duplica+ej Date Issued ------- <br /> ------- <br /> __�--�'-- ••�f <br /> "" """ y This Permit Ex ires 1 Year From Date Issued 2-4 —0L(p-1� <br /> Application is h <br /> arab madehs Sa Joaquin Local Heal+h District for a permit to construct and install the work herein described. <br /> This applica#ion is made in c Iia with County Ordinance N6.' 549. <br /> This <br /> 9 <br /> C ! <br /> F r <br /> JOB ADDRESS AND LOCATI ------ <br /> p <br /> Owners Name_ -- ------ <br /> :.--Ifi- _ �.c-7 = •----------" Phone <br /> RA Q a <br /> Address_..------•--�7� `.._�----•-----.&0� -----:-"[� Phone___..g---- ----------- j <br /> ' -•---- _ <br /> VA <br /> Contractor's Name___-__:-. _._.____..__•.__." Trailer Court ❑ Motel ❑ Other ❑ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Lot size .___"- <br /> Number of living units: ---I-,-- Number of bedrooms . -. Number of baths <br /> _ 4.r -: ,,.� � th to ater Table ft. <br /> F - community system ❑ Private I� kJep <br /> ~�Water Supply: Public system ❑ Y Y a Adobe❑ Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand C3Gravel ❑ Sandy Loam Clay Loam ❑ lY ❑ No <br /> ' ew Construction: Yes No ❑ FHA/VA: Yes ❑ <br /> Previous Application Made: (If yes,date------------ --- -) No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: -- ----_ -n�— <br /> :�.1 i � ,:,.(No septic tank or cesspool,permiffed if public sewer is available within 200 feet:) <br /> _ M tar al__ r!r— — IN <br /> Sept* ank: Distance from nearest well_�7 -=.Dis#an from` f�/ound tion__ - Ca acit � '© <br /> .T. _ �l X _ :_ Llgllld f'je}� h-------- ----'--- p y------------- �_. <br /> No. of compartments_____---�I_. ------Size. <br /> ;`4 <br /> Dis osal eld: Distance from nearest welL__�U=.--Distances from foundation� Disan'ce`to ares+ let(}li��n�....- -------- <br /> p k /___________________ <br /> Number of lines-------------------------------Length of. ach line-----��Q---------Width n trench.---•.��----: <br /> __De th of titer material------------------"---Total length------------------------------------------ <br /> Type of filter material_______________________ p <br /> Seepage Pit: Distance to nearest well_____.____�!jz;rkDli.stanca rom foundation----------------- <br /> 4 <br /> to'nearest lot ine___.___.___.___.. <br /> - -Depth---------------------------------- <br /> ❑ Number of pi --------------------- material . - ------------- Size: Diameter---_•---•---------- - - <br /> ss ool: Distance from nearest well--------------=--Dista�c —r1m foundation---------------- --.Lining material-------.------------------------ <br /> Cesspool: <br /> ---_---- •---- <br /> Ce p --------------------Liquid Ca aci ----------------gals. <br /> ❑ Size: Diameter---------------------- <br /> Distance from nearest well-_______ "._ Distance from nearest building_.____-."______-____.___._______________ <br /> ' Privy: _ ---- •----• ------ - <br /> ❑ Distance to nearest lot line--------------------------------------------------------------- <br /> y <br /> P <br /> Remodeling and/or repairing (describe): !> _^ r�.e^- '.': ``'- -------•3------------- ------- <br /> I <br /> ---•----------•-•-------------- - - -------------- <br /> I-•--•----------•----- °(-'-`------------------------------------ <br /> ----------- <br /> i------••---------------------- • <br /> ' ------ <br /> ---------- <br /> ------------- ------------------------------------------------- <br /> I hereby certify that i have prepafI this application and'that the work will be done in-accordance with-Sart t oagw oun <br /> ordinances, S+ate.laws,. ald rules and regulati ns_of the.San Joaqfy <br /> uin_Local_HealtFi Dis+rice.-. . <br /> ' <br /> -------------- <br /> ------------ <br /> (Signed)---- <br /> ......... <br /> -- --------- --------------------- wner an r on r c <br /> . '' _ <br /> (Signed)_ ,:� <br /> (� �,° <br /> ± -� <br /> ;.;..r.. <br /> - �-- "= " = ---` ------------------------------------ <br /> --------- <br /> r$r- --------------------- -- - ngs, _— <br /> (Plot plan, showing size of lot, location of system in relation to wells, beings, etc., can bs3 placed on reverse side]. <br /> FOR DEPARTMENT USE�ONLY <br /> U <br /> Q'ATE------�"--'` ---&--- •---------------------- <br /> APPLICATION ACCEPTED BY------------ --f- `. _ ,; -v <br /> ----------•- DATE---- ------•-•�-•-•------ -- ---------- <br /> ------------------------------------- ---------------- <br /> -----------------------------------------•---- ------------------ DATE------------------------------------------------------------ <br /> -­--------------- <br /> --Alter-aflons-and/.-or-fa-o,mmendLa+ions <br /> PERMIT ISSUED--------------------------------------------------------- _ �_ ----=y---------- <br /> rt ._.Alter-ations-and/ar-fa-o,mmenda+ions:__--------- ------ ----- f 14C!" `;R;r_ *-----•-----•"---------•---•- -"---- <br /> ,.. <br /> il ------------ ------ �. <br /> _ ------------------------------------------ <br /> ----- ----- <br /> ------------------------------------ - ---- <br /> Date----- J ----•-------------------•- <br /> FINAL 'INSPECTI B <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street _,,, 300 Wert Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> E9.9 REVi3E0 5-39 F.P,co.am 6.60 <br />