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APPLICATION FOR SANITATION PERMIT Permit No.Z. ..:.1 � 3 7 <br /> (Complete in Duplicate) <br /> ...... A This Permit Ex Ices 1 Year From Date Issued Date Issued ..4��. <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 - ade in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION Tee 7T. e <br /> _yy ...�'.....7...T,.. <br /> Owner's Name..... plQ-t <br /> f -....... Phoned. <br /> Address__..{f:. ... <br /> Contractor's Name.:- ----- ),. �• s j.i t ...__ .,u... s' ...r-- ..... ?.. ... _..__.r'.''`?:.....__ ~. one............................... <br /> ............. .... <br /> Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other <br /> Number of living units: Z_--- Number of bedrooms-F.... Number of baths __/ . Lot si ,�� �' <br /> Water Supply: Public system ❑ Community system [] Private Depth to Water Table,� ft. <br /> Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam 0_18a ,y ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made. (If yes,date:........... ......) No ❑ New Construction: Yes•❑ No 0 FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) <br /> Septic T Distance from nearest well..:�-(...a. ..Distance from foundation..../.G?�.....Material � <br /> No. of .Size.�X. -5_.?�_:�iquid depth...... Al"f. --- Capacit . E a <br /> CIP <br /> Disposal 'old: Distance from nearest-well�� _011 Distance from foundation.../D1........Distance to nearest lot line.... --�..... , <br /> Number of lines............'? ......... .. Length Length of each line.........74;....._ . . Width of trench. ..... ......... ......... ...... <br /> Type of filter material....,��t�".S?::G Depth of filter material-----_/��....Total length.. -- � v ,?•/�•. . <br /> Seepage f i±;� Distance to nearest well... <br /> ; .....Distance from •foundation .___f-4?�....Distar)cp to nearest lot line. ... <br /> Number of pits..... _2.r.......Linin� material._, fT :.Size: Diameter.>,7c,7- .......Depth Dap+h... :: ........... <br /> ----- <br /> yy <br /> Cesspool: : Distance from nearest well..... .........:Distance from foundation.. ..............Lining material.... ............... .............. <br /> ❑ --•.,Size: Diameter---- ---------- .............Depth........... ................ .............. Liquid Ca aci als. <br /> Priv r� # q P tY <br /> y: �. Distance from nearest well r <br /> = Distance from nearest building------------- - 0 <br /> ClDistance to nearest lot line............. ................. .........;.�„_ <br /> ........... <br /> Remodeling and/or repairing describe):.... ............ <br /> ..............•---............. ............................. .............. , <br /> ......................................................... ......I.................. <br /> , t <br /> ........................-----------------........................................ .................................... ......................................... <br /> I hereby ertify th`' I have prepare application and that the work will be done in accordance with San Joaquin County <br /> ordinances, fate aws d r d.;r s-ofjhe Sa Jo i Local Health District. <br /> (Signed).... ._. ... .......... t. ,.. <br /> _.(Ownerand/or Contractor) <br /> ----- - --------{Title)....... . .......... <br /> (Plot plan, showing size of lot, location of system_in- lation to wells.buildings, etc., can be placed on reverse side). _ <br /> ( FOR DEPARTMENT.USE ONLY <br /> APPLICATION ACCEPTED BY_...- I r? �%` <br /> .. �7--�.-,_.... .. ........ •---- . DATE-----.Z... . .'. .. ,�....... .. <br /> REVIEWED BY. .......... --•............._............... .. .• •-•--•-••--...-....._.......•-�-------................. DATE............. ..... . ..._ . <br /> BUILDING PERMIT ISSUED.................. .......... ! ---- ..._. <br /> ..... -------------- <br /> Alterations and/or recommendations:.�_... - -L _ E <br /> c <br /> J c�� ............ <br /> . .... <br /> ...... ......... ............................ ...I................._••.-- <br /> ------------- -................ .. .................. .............. <br /> ............ ... <br /> FINAL INSPECTION BY%��......._fNJOAAQUIN <br /> ':�:.`..:L. . Date.....:—�--�•.%.... �.j <br /> LOCAL HEALTH DISTRICT <br /> 1601 E.Noxelton Ave. 30Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California n Manteca,Califomia Tracy,California <br /> Jsti+r t <br /> C9 9 Rtvi560 9•59 3M 2•'63 F.P.Cp. � �� <br />