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"'FOR OOICZ&USE: <br /> ------ - -------------------------------------------- ... Permit No. <br /> ------ ---- ----------------------------- ------- <br /> APPLICATION FOR SANITATION PERMIT <br />- ---------- ------------------------- - --------------- ----- (Complete in Duplicate) Date Issued _71,:�_ate.m. � <br /> This Permit Expires 1 Year From Date Issued <br /> -------- ---------- ------------- -------------- <br /> 'be <br /> Application is hereby made to the Son Joaquin-Loc6l Health District for '*- rmif to construct and install the work herein de cri d. <br /> 7- 1.11 n a M-FC)q <br /> This-application is made in com Iia kIWOTCO unty,dTd� ance.,No.,549,. <br /> .... ........ <br /> W A 23 H F�? -------- <br /> JOB ADDRtSS AND C 0 1; ----- 14/ <br /> ------ Phone------------------------------------ <br /> Owner's NeLM9,---------- A -1 -------------- ——--------------------------------- -- ---------------------------- <br /> /V1 LE 13PK 7 <br /> --- -------- -- A_------ ----------------------------- ------------------------- <br /> Address--- -- --------P % <br /> 11_1 Phone----------------------------------- <br /> Contractor's Name_ -CAR-- — ------------------------------------------------------------------- <br /> ', � 0�f. Commercial 0 1"Trailer Court E] Motel El Other D <br /> Installation will serve: Residence%E�r`fA,partment House [] <br /> I ' : f - Lot size ----- P; 7EF7----- -------- <br /> Number of living unit;: �__A,'Nulmber of bedrooms _3_ Number of baths -Y Ed <br /> Water Supply: Public'system E] . un ifysysfi��M-Lj Private� Dbpth to Water Table/ ft. <br /> Character of soil to a depth!!of 3 fe Comm1 14 I-or Clay [] Adobe [] Harclpan-C] <br /> jjSan ff-__GraveIL3 Sandy lay Loam E] <br /> � ii. 11C N 6 <br /> Previous Application Made: (If yes,Wte( ----------------- No 0" New'Construction: Yes [j No J�J €�A/VA; Yes El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. RA <br /> pu ic sewer <br /> A-100-Me-'t:) <br /> (N67-septic-ta& f is- <br /> o e's �rffiitfia­dl I ' <br /> C I C0fVC-(--F-7T7E=------- <br /> - _____Distance roll foi-injefion-10------------Maf 'al <br /> I. SeptlS>nk: Distance from nearest well--- VT- -------------- ------ 400 <br /> Y <br /> -7i I , -------Capacity---18---------------- <br /> �Lliquid depti <br /> No. of compartments----- I—------ ---Size--- <br /> 0 _*�------- I�L_j ista <br /> -----Distance from founda ion- ------- i,lance to nearest lot line`__)._-__.___. <br /> Disposal Field- Distance from nearest weI14_-_SZ? 7 9-f- <br /> T- Width of trench_ r-------- <br /> 4T-. ... ------ --------------- <br /> Number, of lines----T -7-1-7-V-- ------------Length of each line7--- <br /> .7. .........----- <br /> --Total length-- ---- <br /> maf6rial!_APC,_1_'e,____Depth of filter mat er�'L___._1 --.- <br /> Type of filter <br /> 4j <br /> i <br /> Seepage Pit: Distance to nearest 1_7-------------------DistanGejfromifbundafioh-en.n:7:7-------- <br /> Distance to nearest lot line_________________ <br /> Numberi' of pits------------ --Q----Lining- material)----------- Size:: <br /> Diameter)_.-- <br /> Drameter)---- ------Depth---. ---. ..-- ------ <br /> Cesspool: Disfance from nearest weJ------ ----------Distan e from foundation 1L.Lining materia--- - ------- - --- <br /> -- <br /> ❑ <br /> Jo <br /> Liquid Capacity---------------------- -----gals. <br /> Size: Diameter---------------------------- <br /> ---------DepthJ---------------------------------- ------------ <br /> Distance from nearest building.__._____________________________________ <br /> Privy: Dist.an�e from nearest well_----_.___--_.-----------r-- I <br /> -------------------------------- <br /> 0 DJance_'to nearest lot line--------- ------- <br /> ----------------------------------------------- ---------------------------------- <br /> Remodeling and/or repairing ----------------------­------ ------------I-------------------------------- <br /> ------------------- --------4_5_Y_67)��M ------ <br /> --------------------------------------------------------- - - ---- - ----- ---- ---------------------------------------------- <br /> ------------------ ----------------------------- <br /> ------------I--------------------------j--------------------------------------------------------------- -------------------------------------------------------------- <br /> ----------- ----------------------- <br /> -------------------- ------------------------------------------------------- ----------------- <br /> ----- ------------------ ----------- ----------------------------------------------- <br /> I hereby certify that ]'have prepared This applic6tion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws--a9d•Wles,-and-reguiefions-of-fhe-tSan"Joaquin Local Health District. <br /> ------------- ------------------------------- __(OwneJand/or Contractor) <br /> (Signed)----- ------- <br /> ----------------- --------------- <br /> rO Qonlfrf7ell F, ,6uildings, etc., can be placed on reverse side). <br /> (Plot plan. showing size�of,lofr4ocation o._-s­y�f6ffi--;i­K, <br /> FOR DEPARTMENT USE <br /> -F - ONLY <br /> T—Q-- <br /> DATE-------- - <br /> ------'---'----------------- <br /> APPLICATION ACCEPTED BY__--.--._r t <br /> REVIEWED ----------------------- - DATE- --------- <br /> -- <br /> BUILDINGPERMIT ISSUED------------- ---------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> -------------------------------------------------- -------------------­ �= <br /> ---------------------•---------and/or­recommendafions._!r.­�� tA k <br /> -------;4 A--------- - -------------------------------------------------- <br /> ------------- --------------- - ----------A011--------------- ------- -------------------------- <br /> --------------- --------- --- ------------------------ ------------------------------------------ ------------­ ------------------------------------- <br /> ------------------------------------------------------------------ ..... ---------------------- <br /> - - -- --- ------------------------- ------------ ------------------------------------------------- -------------------------- <br /> L -------- <br /> 1 <br /> 2 <br /> ------------------ -------- -- ---- - --------- ------ <br /> -------------------- D <br /> --------------------- ------------------------------------------------------------------------------------- <br /> - ------ -- -------- <br /> --------- ----------------------- ---- -- ---------- <br /> Date--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> /.......�_46�------------­-------------- <br /> FINAL .INSPECTION B ..."n- ---- --- <br /> 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street. 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />