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1 �e <br /> � 9 <br /> all APPLICATION FOR,SANITATION -PERMIT <br /> Permit No. 3, <br /> ,: t + (Complete in Duplicate) Date Issued -- CC_-���------- ' <br /> ^--kol ca{iori'is hereby made to-the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Ps ' <br /> This application is made in compliance with County Ordinance No. 5��j , <br /> I <br /> ------------ _ <br /> JOB ADDRESS AND. LOCATION_-- -�f_ <br /> _�:....----�--- -.4- Phone2k <br /> Owner's Na -�-•�-f------ - -- --- -•--- ---••-- -­-----------­-------------------- -- - -"------�- <br /> I /-. <br /> ,(p �o <br /> Addre > ------ --- <br /> - ---- -- ------------------- <br /> ��� ------ 'ane __ -• ---- -- i <br /> Contractor's Name_-__„___-______ <br /> : �Hous..� .... . ..m Mo#el ❑ Other ❑ <br /> Installation will serve: Reside0nce� Apartment House ❑ Commercla1 ❑ 7raihr Court ❑ r <br /> Number of livinr units '___.�Nuber'of bedrooms -_3 Number df baths ___-___-JASLot sle __-- - <br /> �3 <br /> Water Supply: Public syste ElCorrimunity+system ❑ Private depth to Water Table ft. p <br /> ' Gravel Sand Loam ❑ Clay Loam-fl Clay❑ Adobe Hardpan ❑ <br /> Character of soil to a dept 3 feet: Q ❑ Y l ' <br /> Previous Application Made: Yes ❑ E N11 <br /> New Construction: Yes ❑i No <br /> TYPE OF INSTALLATION AlND SPECIFICATIONS: <br /> No septic tank or cesspool permitted if public sewer is available ithin 200 feet.) <br /> _. _ <br /> _ __ <br /> ep ' Tank: Distance from near st well_____________ ___Distance from foundation. <br /> L quid dspth__Material # _Capacity_________._,----__---• <br /> No. of.compartmen}s> `-= - _.'Size._ =�_ - + p Y <br /> 4�ADisposal laid: Dis+anterom rsearest we{}. d-f_____Distance from foundation___ Q--.-.----Distance to nearest loft line__ _ -- <br /> _Len th of each line_---_-Q-- ---- --= Width of trench_.__t�<�--01 <br /> ------------ <br /> Number oz lines- '-�--_ 9 r 1 r <br /> -Depth of filter°material----!` t�-.-_ Tot`a1"1enght--- Q--•----- <br /> Type of filter material_��i 5 <br /> 1. .......-”"� r <br /> Seepage Pit:f Distance to nearest ell.- ______________Distant r f undation__ �` ---Dista�ce to nearest bine_/_ _____ <br /> Size: Diameter1C33- ......!_.Depth D[`S' -------------•-- <br /> ' Number of pits.__._--.--------LEning mafie --- l <br /> .o� s. <br /> Ces" spool: Distance ;from nearest well_________________Distr-ance from foundati --------------------11 ILing mahenal__.____.____._______--------------- <br /> ► , `_ UIry uld Capecity--------:--------------------gals. <br /> `� y <br /> ❑ Siz;:f Diameter;----:-=----------------- : Depth = = -------------------------------------- <br /> Privy:' Distance}romnearestwel4--------------------- --- - <br /> _-- ________--Dista from nearest building._ <br /> ❑ , <br /> ;.-- ---------- - - - ---------- ---- <br /> Distance near <br /> Remodeling <br /> line--- - <br /> Remodeling and/or repairing (descrlbe7 ----•----•---------------.-- - ; #.. _: <br /> ---- ------ - z <br /> ------ --------•-----------------•--------------------------- <br /> I ----------------------------------------- <br /> .._ y. <br /> -- <br /> - --------------------------------_ a that the work wiN be •-----------------iSa ---qui -- <br /> I hereby ti fhat l have prepared this a licafion al#h <br /> r ------- <br /> --------- - - � done in accordance with San Joaquin County <br /> d r.1 n regulation of the San a uin.Local'� a District. <br /> ordinances, St I s; � , :_I <br /> E <br /> caner and/or Can c# <br /> �-----N <br /> tra or <br /> [Signed) <br /> ----------- <br /> r F Title <br /> Plot Ian, showing size of to+j location of system i ala ion to wells, buildings, etc., can be placed on reverse side}. <br /> P r <br /> r FOR DEPARTMENT USE ONLY <br /> s f" <br /> --- -�'-"-:".--_------------------------ DATE---- ---------..`-------� -�------------i-- ----- <br /> APPLICATION ACCEPTED BY---------------------------- 1 DATE - <br /> ---•------- <br /> REVIEWED BY-------------------- e DATE ----------•------- <br /> BUILDING PERMIT ISSUED :--------------------=------- <br /> Alterations and/or reco endatio A__•=- <br /> j <br /> -- --------- <br /> 1 - - -- -- -- .- ..... <br /> ___________________________________ _ _ <br /> . -_____________________ .� - -___.__--..____.___..___ <br /> Li <br /> ` Date-- ----�----• -- --�,�-�� ---- -----=--- ----------------------•---- <br /> FINAL INSPECTION'BY: <br /> -- .r SA JOAQUI LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street B!4 North "C" Street <br /> 130;South American Street 300 West Oak Street Y Trac California <br /> Stockton, California <br /> Lodi, California Mantaea, California Y. ,r <br /> t. <br /> cc- o—�A1 Revised W-2100 -- <br />