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rkJK urriLx u�t: <br />---------------- -- --- ------------------------- ------- <br /> -------------------------------------------------------- APPLICATION AFOR -SANITATION PERMIT Permit No_;�_Z��f <br />----------------_------------ -------------------------- (Complefe'll'I 'Duplicafe) Date IssuedOO <br /> ----------------------------------- ------------------ This Permit Expires 1 Year From VaTG Issued <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 compligrice with County Orclin6nce-r No. 549. r' CY77­0 S <br /> JOB ADDRESS AND LOCATA <br /> Owner's Name-------------------- <br /> -------- -------- ------------- Phone----- ------------------------------ <br /> Address------------------------P_Tz _]--------1:30>c----------3�---------4,47- a-Ir.....! <br /> Contractor's Name----0WJV_F—__19-- ---------- ------------------------------------------------------- -- ------- Phone.... <br /> .......... <br /> f ;----------------------------------- <br /> Installation will serve: Residence [Apartment House E] Commercial E] Trailer Court El Motel E] Other E] <br /> Number of living units. I--- Number of bedrooms-3-- Number of baths ----/ Lot size <br /> 7.,$ 5 PF—K <br /> P40A_,,�r i" -rests <br /> Water Supply: Public system E] Community system E] Private ErDepfh to 'Water Table :5 <br /> ft. , 0,V111610AI � <br /> Character of soil to a depth of 3 feet: Sand [Gravel E] Sandy Loam E] Clay Loam Ej Clay [:] Adobe [] Hardpan [-] <br /> Previous..Application Made: flf yes,date.__.-- _- -------) No kR"'New Construction: Yes FHA/VA: Yes Er'No D <br /> TYPEOF INSTALLATION AND.SPECIFICATIONS: <br /> ­­(14o_sepfic­i,_nk`®r c_iesi_po_,I_per�ifte_dif public sewer is available wi+hin'200 feet.) <br /> Se nk: Distance from nearest well____5_D....Distance from founaafipn_____/0-----..Material------COAKRE�T-f--_ <br /> pe Na, of compartments' �-7 S;ze--Lzu-11OX-1 _iquid clep�h_ ------------ <br /> 7-Al ------Capacity-,---Z.;�Po <br /> --------------- --------Disposal R Id: Distance from nearest well...±�.0--.-Distance from'foundation---/0------..--Distance to nearest lot <br /> Number of lines-----------_2-------------Length of L each line---------75___� Width of trench­-------2!4!_ <br /> Type of <br /> filter material---j�0_C_X-­___Deptfi­'of'flfet, Material-------1-7--------Total length----------------------- ------ <br /> ,a <br /> Seepage Pit: Distance to nearest well_ -- <br /> ---_---- --------Dis; nce from foundation--------------------Distance to nearest lot line__-__-_.-___ -- <br /> El Number of pits----------------------Lining ma6ria1_____,................Size: Diameter---------- ---------r---Depth-.--.-.----------------.--------_ Iriz- <br /> Cesspool: Distance from nearest w❑ ell---- ....Distance from foundation--------------- ....Lining material-- ----------- 0 <br /> --------- ------------------ ------- <br /> Size: Diameter-------------------- Depth------------------------------ ----- ---- ---------Liquid Capacity----------------------------gals. <br /> ----------------- <br /> Privy: Distance from nearest , ell------ --- ------- ------------- Distance from nearest building-------------- <br /> ------------- ------ <br /> F1 Distance to nearest lot line- -------- ---------------------------- <br /> Remodeling and/or repairing (describe):---jCH.A_AfG_E0-----:--_P 444-[t&--------FOR--- :D ------Vhk(r=------A/0-T_ <br /> ---------------------------------------------------------RUILP---!_------------------------------------------------------- --------------------­___---------------------------------------- <br /> --------------------------------------- .1---------------V_ M........I—---------------- ----- -------- ------ ------ <br /> ----------------- -A(CF _A__2 __ _-------I 4� ----------- R <br /> --------_C-A -------------------- F_R---- ---------------------------- Z-�� ----- <br /> .... i /-_ --- --_ <br /> I here, y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> L <br /> _4tate laws, <br /> ordinance and rules and regulations of the San Joaquin Local Health District., <br /> (Signed)-- ---------------------------(Owner and/or Contractor) <br /> ----------------------------- <br /> -------------------- ------------------­I------------------------ -------­----------------------------------------------------- (Title)- <br /> (Plot p an, 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-- ------------------------------------------------------------- DATE----------- <br /> REVIEWEDBY---------------------------------------------:---------------------- --------------------- ------------------- DATE <br /> BUILDINGPERMIT ISSUED------------------------------------------------- -------------------------------------------------- DATE------------------------------ ------------------------------ <br /> Alterationsand/or recommendations:____--_______________:- ------------------ ---------- ----------------------------I---------------------I--------------------------------- --------------------- ------------------ ----------------------- ----•------------------------- ------ <br /> ------------------------- ------I----------------------------- -------w----------— --------------------------------- -- <br /> --•--------- .------------ <br /> FINALINSPECTION BY:------------------------------------------ - ----- -------- Date--------_----------------------- --------------------------------------------- <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 <br /> Tracy,California <br /> F.P.00. <br />