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FOR OFFICE-USE" <br /> ------------------- - <br /> -- -------------- <br /> Permit No.--------------- <br /> ----------- ---------------- APPLICA,,-JON FOR SANITATION PERMIT <br /> ----------------- ------------------- -(Complete in Duplicate) <br /> -- ---?_ Date Issued -A <br /> -------- l <br /> ----------------------------- ........j�----------- This Permit Expires I Year From Date 'Issued <br /> Application is hereby made to the San'Joaquin Local Health District for,p permit rmit to c fl insfa <br /> construct an 11 the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. Y-2 1 <br /> ON- <br /> ----------- <br /> - ------------ <br /> JOB ADDRESS, AND LO 9 10 fi-MI-11--- ---- <br /> 3F 1 -----------------------------I----------------- ----_ _Z3?j <br /> Owner's Name-DUA.l,----CO-1....r.-- -------------------- Phone_.!!K6_,_%3----------:--------- <br /> �ry <br /> -------------------------------------------------------------------------------------------------------------------- <br /> Address--'--.--------- ---------- <br /> Contractor's Name- ` -# ------ -----------------­---------------- ----------------- Phone <br /> 'd 'r El <br /> Installation will I serve: Resi eyn Apartment House [3 Commercial L] Trailer Court [] Motel [] Other <br /> 4C <br /> Num*'of living ------ Number of bedrooms -)--"`Nurnber of baths __/._ Lot size ---Z2&4r_4-_icPr -.�________________ <br /> Water„Supply: Public system El Community system El"'Private P--<epth to Water Table6-oft. <br /> Character of soil to a depth of 3 feet:- Sand L] Gravel E] Sandy'oa`m Ej Clay Loam Q Clay 0 Adobe B--`Hardpan C] <br /> P1. revious Application Made: If yes,daie.... _1 No El New Construction: Yes-[] No Pl-_'FHA/VA: Yes Ej No El <br /> Wh OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within-200 feet.) <br /> 4 <br /> Distance from nearest well_________________Distance fr"orn foundation--------------------Material-------- ---------------------------------------- <br /> No. of compartm4nfs--------------------------Size--------------------- ------I... <br /> osa �e d: Distance fromnearest w Liquid deI6�h------------------------- Capacity----------------------- <br /> Distance from foundation.10-------- Distance to nearest lot line__ ____ <br /> _t ' �r <br /> ------------- <br /> Number' of lines--,--[-- -------- - ----Length of each line-41---a-f------- _Width of trer <br /> Type of filter materia of filter material------ ---Total length______.:------_----- ------- <br /> from u n <br /> Seepage Pit: Distance to rieare t welh. "--f---------Distanf fo nclation_-_-�... Dj.'t to eare'st lot,line--l—e---- <br /> LS !2DCP1 10 <br /> Diameter-_-t ----'--_Depth-5 <br /> ---------- <br /> Number of F -------- ------Lining material_ 0: <br /> Cesspool: Distance from nearest well-----------------Distance m Cundscion.-._...______ .___.Lining material______._______________._-________._. <br /> !� " J---Liquid Cap�acity--------------------------­gals, <br /> ❑ Size: Diameter------------------ ------------------ --Deptht-------------------- ------------------------ a <br /> P <br /> Privy: Disfance.from nearest.well-------------- -----------------------------------Distance-from nearest building----------------------------------------- <br /> Distance to nearest lot line------------------------- --- ------------------- ------------------------- ------ <br /> --------------------------- ----------- <br /> Rem6deljn6 and/or repairing (describe]:__ ----------------------- <br /> ------------------------------------------------------------------------------------------- ------- -------------------------------- <br /> ---------------------------------------------------------------- -- --------f-----------------------r--------- --- ---- --- -- --------------------------------------------------------------•-- !`---------------------- <br /> ---------------------:-------------- ----------------- <br /> ------------------------------------- ------------------ --------- ---------------- ------------ -------- --- ---- -------------------9-------­------------------- <br /> ---------------------------------------I-------------------------------------- <br /> --------------------------------------------- - ----- - -- -------- - -- --------- <br /> I hereby certify that I h prepared f is application and at the work will be done,in accordance with San Joaquin-County <br /> ordinances/fi0fe I s, an rules and regulations of the San Joaquin Loial Health District. <br /> EF -Contractor) <br /> (Sign ---------- ------------------------------- <br /> F---------- <br /> By:--------------------- - - ------------- ----------- ---------------------------- _-, 4-1-----—- ---_--(Title)7------------------------------------------------------------- <br /> (Plot 'plan-, showing size of lot, location of.system in rela+i to wells,.buildin$V, etc., can be placed on reverse side). <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- <br /> ------------------------------------------------------ DATE_---- -------- ------------ <br /> REVIEWEDBY---------------- ------- ------------ ------------- ------------ --------I--------- DATE------------------- _A--------------------------------- <br /> BUILDINGPERMIT ISSUED-------------- -------------------------:----------------------------- ---------------- DATE----------------------------------------------------------- <br /> ------------ <br /> --------------------_n= -------/ --------------- <br /> Alterations and/or recommendations _____._ <br /> ------------------------------------- ---I------------------I------------------------------------------- --------------------------------------------------------------------------------------- ------­----------------- <br /> ---------- ------ ------------------------------------------------------------------------------------------------ -------------------------------------------m------------------------------ ------­____:-------- <br /> -------------------------------------------------------- ------------------------------------------------------------- ------- -- ---------------------------------------------------- ------ -------------------------- <br /> --------------------- -------------- --------------------------------------------------------- ---------------------------------------------------------- -------------------------------------------------------- <br /> FINAL INSPECTION BY_ ------- Date---- --------- -------- ------------------- <br /> -4- - I <br /> SAN JO.AQUIN LOCAL HEALTH DISTRICT 4- 74 <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street*�_A 205 West 9th Street <br /> Stockton,California Lodi,California Ma"nIeca,California a Tracy,Cali-fornia 4�.. <br /> ES 9 REVISED S-S!) 3M 3-'63 F.P.CCI.�, <br /> �_4 <br />