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' �IOOFFICE USE: ' =' . <br /> R 3 � Permit No." " APPLICATION FOR SANITATION PERMIT <br /> ---- ------ <br /> ----- -- b <br /> (Complete-in Du licete Issued <br />- - ---:- ----- --- -- -- -- - ------- -�--- P I Date Issued --, <br /> This Permit Ex ires 1 Year From Date <br /> Application is hereby made to the San!Joaquinu�otcalO dealtncblNoC ffor <br /> a permit to construct and install the work herein described. <br /> This application is made in complianc,Iwlth Ca y <br /> -- ----- - <br /> -- <br /> Phon A LOCATION �,3 0S--- <br /> J08 ADDRESS ' -- - - - ----------•--------------------- <br /> ------ <br /> owner's Name_ ------------ <br /> Phone------ •--•------•------- <br /> Contractor's Name---- ----•- Other <br /> Commercial ❑ Trailer Court ❑ Motel ❑ <br /> Installation will serve: Residence Apartment House ❑ k0 D ------------------"- <br /> Number of living units: A---- Number of bedrooms .-.2— Number of baths.-J---- Lot size "'f <br /> -- <br /> �� }h to Water Table .fo_3. ft <br /> Water Supply: Public system ❑ Community system ❑ Private L61 eP <br /> PP y• Clay Loam � Clay ❑ Adobe[Hardpan ❑ <br /> I Gravel 5a�dy Loam ❑ y <br /> Character of soil +o a depth of 3 feet Sand ❑ ❑,�]/ <br /> No New Construction: Yes ❑ No FHA/VA: Yes ❑ No <br /> Previous Application Made: llf yes,date_-..------ $ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> (No septic tank or cesspool ptarmit+ed if publicsewer is available within lon feet.} <br /> Septic Tank: Distance from nearest wei} - Q."_-"_Distance from foundation.__ -- Ca acitQ° � <br /> �/ No. of compartments..--..' Size----- -°C- Liquid drepth-- p y <br /> Distance from foundation-M-------------Distance to nearest lot line --------------- <br /> Disposal <br /> ._-..._...__.Disposal Field: Distance from nearest wells.----- - - Width of trench.__. '�---------------------- <br /> �� Number of lines---f-------------- Length of each line.lr'-------- - <br /> Type of filter material_-"�E'- - DEPth of filter material..-ZW7-r-r-------.Total length----./ �=----- -- - <br /> �� ,� <br /> Seepage Pit: Distance to nearest will_- O...---- Distance rom foundation_..-__ D t c to nearest lot line_ <br /> . � _ Depth.- --�Z'-------- -------- <br /> Number of pits..- _.._.- Lining material..__._���- Size: Diamete <br /> . --- -- <br /> material- r <br /> Cesspool: Distance from nearest well ------- ---=--Distance from foundation.:-------- _Luningquid Capacity.. ... <br /> Size: Diameter. --- ----- ... -----------gals. <br /> ❑ <br /> Depth. ------ ------ <br /> r Distance from nearest well---------------`----------------- <br /> _Distance from nearest building....................................._.-. <br /> Privy: � .t ...... w <br /> p ❑ Distance to nearest lot line ---------------. ............. <br /> ---------------------- <br /> -------- --- ------------------ -------------------•------•-------------- --------------------•-------- <br /> Remodeling and/or repairing (describe)----------------- ---------.-.------------------- - <br /> ---------------- <br /> -------------------- ----- -- --------------------------- <br /> ----- -- <br /> -- ---------------------------------------------------------- ----------------------------------------------------- �- ------------- <br /> ------------ <br /> --- � - <br /> done <br /> I hereby certify that I havelespredareduthis lat ons Ili the San Joaquin the <br /> workcal Heall heDistr ctn accordance with San Joaquin o u n <br /> wi <br /> ordinances, State laws, and ru 9 <br /> k' ------ ------(Owner and/or Contractor) <br /> (Signed) <br /> t l ------- -------------------- ------- ------ <br /> (Ttt e . <br /> --------- -------`----y-------- - <br /> f (Plot plan, showing size of lot, location of system <br /> in vela+ion to wells, buildings, a+c., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY t <br /> DATE--- ---- <br /> APPLICATION <br /> -- ------------------------- <br /> BY_ <br /> - <br /> APPLICATION ACCEPTED i3Y__. .;_ -- -- <br /> REVIEWED BY-------------------------------- <br /> -----. - - -- <br /> ------------------------ DATE---•--------------------- -- ---------- <br /> BUILDING PERMIT ISSUED-------- - ------- ---------------------------------------—---- <br /> -------- ---� DATE---............................... - - <br /> 1 <br /> -- . <br /> Alterations and/or recommendations:---------- ------ ---._-"-.----_-.._.... <br /> ----- -------- - <br /> i <br /> ----------------- <br /> -- -- - -- --- <br /> Date'------- - - --� <br /> FINAL INSPECTION BY:...-__._'__ .- ---- - , <br /> F t SA QUIN LOCAL HEALTH DISTRICT <br /> F 1601 E.Hazelton Ave. 300 West Oak-Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Lodi. California Manteca,California Tracy,California <br /> i Stockton,California . <br /> E,H.9 2M 1-67 Vanguard Press <br />