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FOR OFFICE USE: <br /> -----✓�� -�- - = err ,r--f----- <br /> -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 131. .7.4. <br /> -- ------------------------------------------------------ (Complete in Duplicate) <br /> r' ____ This Permit Expires 1 YeaF from Date Issued Date.-.Issued-_..:_._,3_ <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 compliance with County Ordinance No. 549. ! <br /> JOB ADDRESS AND LOCATION 'b--e--------W­-•--- ---•-••--------•----••--------------------------------------- ------------ -------- <br /> Owner's Name------Mit_..._ .r.7 A.. . � ---------------------------------------- -----------•--------------------------- Phone.. ?.,.. ... <br /> Address-------- -----------�=�----------- ----- --- ----------...----------------•------- <br /> � � f <br /> Contractor's Name------ ---------------------•_.--.--------------------------------------------••----•--•---••--•------•-•------.---. Phone...................__------------ <br /> Installation will serve: Residence �, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> {Number of living units: ___I___`Number of bedrooms __Z__ .Number of baths A._-_ Lot size .3 i O t x �{(�B i------------------------ <br /> Water Supply: Public system ❑ rCommunity system ❑ Private K Depth to Water Table __LO_ ft. <br /> Character of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe❑ Hardpan El <br /> Previous Application MIade: {If yes'date---------- -----) Nog New Construction: Yes K No ❑ FHA/VA: Yes ❑ No X <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 3 <br /> (No septic tank or,cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well___ __E?`____Distance from foundation----LQ'.---------Maferldl-NAA_-,MA_._sil.__°te,us! :�. <br /> �[ Nod of compartments______Z------------ <br /> ____Size__3{75r._•-Liquid depth......................--_Capacity...Sgd_ <br /> Disposal Field: Distance from nearest well--_moo`___.Distance from foundafion.___L.t�!---------Distance to nearest lot line.__.,..`'_'..... <br /> Number of lines__------7-_________-___________Length of each line-----1}O----------------_Width of trench__ !__-__.'_________ f_ <br /> Type of filter material----�_C?s�s.--_.___._Depth of filter .material-------)_$."--------Total length-----�(la�_�_________________________ vV <br /> Seepage Pit: Distance to nearest well-------____-----------Disfance from -foundation....................Distance to nearest lot line--------_-------- Uj <br /> ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----------------------__-------- <br /> i <br /> Cesspool: Distance from nearest well_________________Distance from foundation---------------------Lining material----------------------------_________. <br /> ❑ Size. Diameter-r------------------------------------Depth--------------------•------•------ -----------------Liquid Capacity-------------------------- <br /> -gals. <br /> Privy: - . - Distance from,nearest well-__._..________________._______._________._Distance from nearest building_________________________ ` <br /> ❑ <br /> Distance to nearest lot line---- ----------------------•------------------------------------------- -------------------------- <br /> t <br /> Remodeling and/or repairing3(describe):________.____._____________ i <br /> . � I <br /> cavi-" - - ---{------- <br /> I -----•------••------------- ----------=------ ------------------------•----------------• - •------.......----------------------------------------------------------------._•...-"--------------------- <br /> z ----- <br /> L t L i <br /> ----- <br /> I hereby certify that;l•have`prepared this application and that the work will 6e done in accordance with San Joaquin County <br /> ordinances, Sta ws,ta--d rules <br /> ant of4fheanJoaquin Local Health District. <br /> (Signed)---- --• ---------- -;. ----- ----------- --- --- <br /> (Owner and/or Contractor) <br /> By: _ - ---- ------------------------------------------•---------------(Title)---------------------------------------- <br /> � <br /> - - --------- ----- <br /> (Plot plan, showing size'of-lot;`-location of system.in relation to wells, buildings, etc., can be placed on reverse side). <br /> 1 j FOR DEPARTMENT USE ONLY $ <br /> APPLICATION ACCEPTED--BY-------iC------ --' '-"-"------------------------------------- --------------- DATE_._._a_-__�---�. ' <br /> REVIEWED BY-_.......l------ ._ _=....=rte . __- -}= DATE I <br /> BUILDING PERMIT-ISSUED__=___-___->____ ______-__-(_ ''mow'' <br /> --••--------- ----------------••---------------- ----------- DATE ----------•---- <br /> f <br /> and/or recomm Inflations:_____..__.___.__;___ _-- ____.. -------------- <br /> --------------------------- <br /> Alterations _---________ <br /> C s <br /> _ <br /> ---------- ------------------- ----------------------------------------------------------------------------------------- <br /> ------ ----------------------------- <br /> i. <br /> I "=•-•---------•-----------------------------------`----------•---- <br /> 1 <br /> FINAL INSPECTION`�BY:----"-,:- ----.---•--- - ---- 'oE _-Date-7 - ----------------------------------- <br /> 5---------�---------------- ------ -------------------------------- <br /> SAN JOAQUIN LOCAL HhALT'H_D,ISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />{ Ce-9 REvie FD e•69 F.P.Co.ZM 6.60 <br /> l <br />