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Z -FOR OFFICE USE: �f:� , <br /> APPLICATION FOR SANITATION PERMIT Permit No. __1--7_�---------------------------------------- ----- <br /> . .__ <br /> (Complete in Duplicate) <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued __ _;j. E7 <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,c pliance with County Ordinance No. 549. <br /> CP, <br /> 'JOB ADDRESS AND LO ATION___._ ------ -------1-]-�PfV----- _JAN'( D`�--------------- <br /> --� -> a-n�--------- .1-�-•�M-- ----- <br /> Owner's Name------------- - 4---..- Phone Phone-------•-----------------------•-••- <br /> Address............ Y —1 —.. --------= `, <br /> Contractor's Name-----------ov1!i�a_�._ .- -iij-------- Phone----------------------------------- <br /> Installation <br /> •----- •-----••------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --(---__ Number of bedrooms __�L__-_ Number of baths __j___ Lot size -----A-9___-._7ALR r-__._______-____.- <br /> JF <br /> Water Supply: Public system ❑ Community sys m ❑ Private Depth to Water Table _ _ __ ft. <br /> Character of soil to a depth of.3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan.❑ <br /> Previous Application Made: (Ifyes,date_ _______________) Noo_�_New Construction: Yes �1o�❑ FHA/VA: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> - — (No septic tank or cesspool permi#ed.if public sewer is available within 200 feet.) <br /> Septic k: Distance from nearest well4aP_- _D' <br /> isctancv from foundation__Io-------____.Materiai__C - l✓T =__ Z ��. <br /> p �� .. Sizes./. a x. pr r <br /> Dis osal field: Distance from nearest ,well. :_____Distance r�_s�,_foun °in uid.� h-__��y,-_____-.Capac�tv__-1_�D <br /> No. of com artments__-__.,_ .___.-_ <br /> p . _.-_-Distance to nearest lot line____________ <br /> Number of lines---•---�- -- ------------------Length,of,each7line,,r Width of trench-------1 _-•-----✓"___-- <br /> T e of filter material- hG}; Depth of filter material----- length-------------- ________-____.-__-. <br /> 0. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------A____.Distance to nearest lot line--.----_-_-..-_-. <br /> ❑ p g ------- Depth----- -------------------------- 1 <br /> Number of Its____________ ________Linin matenaL_______._.___.-_______Size: Diamete�i__________.- ._ <br /> Cesspool: Distance from nearest well'"`_"_"_'"___Mstance from foundation----------__1_ Lining material______________ <br /> - C ___ ___________________ <br /> Size: Diameter-----1 y Z-------------------------Depth------------------------------ ------- --.- �_ gals. <br /> G <br /> Priv 4Dist;n-ce,from,_nearest well_______________-_-_'---------------------------Distance from nearest building-_-________________ <br /> y: _ ______••---=-------_--. t <br /> # i <br /> Dlstagce to nearest lot line - ------ ----------------------------------------_ - ----------------------------------- --#- <br /> Remodeling and/or repairing (describe)___________________________________ r <br /> --•-------••------------------------------------------n-------------------------------------------------- •-----------------------------------------•----------------- tJ <br /> 1 r <br /> I hereby certify that I 'hevelprepared this application and that the work will be done in accordance with San Joaquin ECounty E <br /> ordinances, State laws, and iu les- d�eguletions-off th Sart Joaquie'LTcahHealth District. <br /> (Signed)------ t-7_V----- -- - -- - " I-----(Owner and/or Contractor) <br /> gy.. . --- ----------------------------------------------- ( it --= _ =------- --------- <br /> - T.le) <br /> (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc., can be placed on reverse side). <br /> `� QQ FOR DEPARTMENT USE ONLY J� <br /> APPLICATION ACCEPTED BY-------- 1.1 =C ------------------------------------------------------------------ DATE------f---7=---6y- ---------- ------------------- <br /> REVIEWEDBY----- ------------------------------------- -------------------- ------ DATE------------------------------------------------------------- <br /> BUILDING'PERMIT-'ISSUED'--�"`----'--.W: .._ DATE = == ---------------'-- - � � <br /> --- -------- ------------------------------------------------------`-=— <br /> Alterations and/or recommendations:-------------------------- ------------A-'"-------- _= =-------=---------------------------- <br /> --------------------------------------------------- <br /> rirr V1 <br /> --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------- ------------------- ---------- ----------------------- -------------------------------------------------------------------------------------------------- --------------------------------- <br /> FINAL 1NSPECTIO ----- ------- Date---- -------�77i4 4_1----------- ---------------------- <br /> I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Noxetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED B-59 3M 3•'63 F.P.CD. <br />