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FPR OFFICE USE: <br /> --------------- W------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------- ------------------ <br /> --------------------------------- --- ----------------- I'Omple4e in Duplicate) Date Issued <br />------------------------------ ------ ----------- This Permit Expires 1 Year From WaTO ISSUOO <br /> A true and injall=heork herein d §ed.. <br /> T�plicatipn �s herb to the San Jo in ocal Health District for a permit to� n tru _Iscr <br /> Ion I e i o li n my Ordinance No. 549. 0 - <br /> applic t I <br /> --------------------- �8�----------------------------------------- ----------- ------------ <br /> JOB tion <br /> LO ATION-_- - ----- --- <br /> ---- -------------------------------------- ------ <br /> Owner's Name-------rahc---------T;;t ....V------�A------------------- ----------- -------- -- <br /> Address------------------------------------------------------------------------------------------------------------------- ------- -------------------------------------------------------------------------------- <br /> t_-w <br /> Contractor's Name-------V-lft.UL i 6-4....... ..0.0,----------------- ------ -----_--------------------------------------------------- Phone..-1 <br /> Installation will serve: Residence X Apartment House [I Commercial F1 Trailer Court Ej Motel [-1 Other D <br /> Number of living units: A---- Number of bedroom's _1_____ Number 0'f..baths ___I.-. Lot size -----2--tt---Aefi VA--------r-------- ------ <br /> Water Supply. Public system E] Community system E] PrivateK Depth to Water Table _4_0 ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam 0 Clay LoamIZ Clay C] Adobe E] Hardpan 0 <br /> Previous Application Made: (If yes,date--- --- ---- -------) No New Construction: Yes No Ej FHA/VA: Yes ❑ N OA w <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest weli-----%5_0-----Distance from foundation-----].Q- _Materia}___ <br /> --- <br /> - - ----- - ---- <br /> - -------- <br /> No. of compartments-------1� -- <br /> ------- ---SizeJ�,' __?�,5_._$X___Liquid clepth----------IV-5-� Capacity----------------- <br /> - <br /> r ---- <br /> Disposal Field. Distance from nearest well---5. ._..._. Distance from found ----Distance to nearestlot line___j_A 0 <br /> Number of lines------------)---------------------Length of each line------------V0.. .. <br /> ... .....Width of french-------------- 2 <br /> - -15,11, <br /> Type of filter material_ j5 Depth of filter material--------1i _ Total length--------------------------- ----------- tj <br /> Seepage Pit: Distance to nearest well-----/ .........Distance from foundation------/'!!-'----.Distance to nearest lot line---- 1---- <br /> Number of p;fs-------/-------------Lining material -Size: Diameter------4W------- Depth_-_.__.__._. ------------ <br /> Cesspool: Distance from nearest well_________________Distance from foundation-------------------Lining material_---.-------_______.____________ _- <br /> ❑ <br /> aterial--------- --------------------------- <br /> El Size: Diameter--------------------------------- ----Depth------------------------------------ --------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest we4l--- ----- ----------------------------------.-Distance from nearest building----------------------------------------- <br /> ElDistance to nearest lot line---------------------- ---------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or re aiprin? describe):----__._- -------- -------- <br /> ... ------------------------ ---------------------------------------- k, <br /> _4 <br /> ------Al-oe, ----------- ----- --- ---------- ------------------------------------------------------------ ------------ <br /> ------------------------------------------------------------------------------------------------------------------I------------------------------------------------------------------------------------------ --------------- <br /> ---------------------------------------------------------------------------------------------------------------------T---------------------------I---------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------------PAxe <br /> 7--------- ---------------------------------------- -----(Owner and/or Contractor) <br /> - '7----------------- ---------------- ---------------- ov V <br /> ---- ------ ---; -(Title)------- ----------------------------------------- <br /> By:--------------- 1141�__ --------- - <br /> 04e ----- . . ------------------------------------------------------------------ <br /> (Plot plan,.showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- <br /> --------------------------------------------- DATE--- -------------------- <br /> REVIEWEDBY---- ---- ------------------------------- ----------------------------------------------------------- -------------------- DATE_--------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------- ------------------------- -- ------- D E_ ------- --------------- <br /> Alterations and/or recommendations..-- r....... ------------ ------ -- --- --- --------- <br /> - -- ------- <br /> ------------------------------------------------ <br /> ------------------ ----------------------------------------- -------------------------------------e)�---------------------- ---------­---------------- <br /> ---------- --------------------------­------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------- ------------------------- -------------------------------------i----------- ------------------------------------------------------------------------------------------­-------------------------------- <br /> ------------------------------------------------ --------------------------- ---------------- -- ---------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY------------------------- ---- Date------------ .---- ------------ ---- <br /> d' <br /> -------- <br /> il 0 'A <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 4 RIEViSED B-59 3M 3-'63 F.F.120. <br />