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FOR OFFICE USE: <br /> ----------------------------------------- <br /> . <br /> APPLICATION FOR SANITATION PERMIT Permit No. .1. ...... <br /> ------------------- <br />------------------------------ <br />------------------------------ - - --------------------- (Complete in Duplicate) <br /> Date Issued -------- t ..... <br /> 1. <br /> ----------------------------------- -- ------------------I This Permit Expires I Year From Date Issued <br /> 'b <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 Xal"cation is made in co 1' with County Ordinance No. 549. <br /> T�Iiance w — <br /> JOB0 0( 1 ------- `..»..-""_-------I........-"_...._.... <br /> AA L �Tl <br /> Owner's,Name-------LM 44<--------4.%..... ....................... <br /> ------------C1-1__.._-_.____ ' <br /> C ........................... <br /> Address_._...... ).-712.4.;........520......... ......... .............. ------------------------­-------------------- <br /> Contractor's Name-------- W tl t7r, --------------------------------------------------------_-------------------...... _ Phone...............--------_-------- <br /> Installation will serve: Residence P-_.-Apartment House E] Commercial 0 Trailer Court E] Motel [] Other 0 <br /> t <br /> Number of living units: j .3 <br /> ---- Number of bedrooms . -- Numbaths --/... Lot size _-_-_14-2. "' <br /> f <br /> Water Supply: Public systemPrivate ;/r stem El Community system [I Depth to Water Table /2--ft. <br /> Character of soil to a deitpfh of 3 feei: Sand Vj"Gravel O.Sancly..Loam�M:��-Gla y_Loam_Q,,CIay_0 Adobe 0 Hardpan [I <br /> Previous Application Made: (If yes,date----------------T77�p J2` New_6onstruction: �tes 0-14o E] FHA/VA. Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECII-l%_A11UNS-. <br /> (No septic tank or-cesspool permitted if-public sewersavaila <br /> blwithin 200 feet.) <br /> ante <br /> from foundation------Vi9 _.Mat t piall REED 0 0-b. .. ....... <br /> Septic�Tank- Distance from nearest well...5— __..Dista e f ------ a --- - ------ ---W...... - - - <br /> Nom: -1 T laii 46 -5 <br /> Liq,id)depth....... ------ --------Capacityl_.ZQ52.... <br /> No— of compartments..-.._2------ -------- <br /> Disposal Field: Distance from nearest well_____ ___Distance from foundation____- ---------Distance to nearest lot line---)l----- <br /> Number of lines------------�7-------- Width of trench----------3b- -------------- <br /> Ty p. filter _Depth of filter material----Z ---- <br /> -- <br /> ___.-.Total length--------- .... <br /> . ................ <br /> I <br /> Seepage Pit: Di.26L to nearest well----------------------Distance from foundatiorF----_------------Distance to nearest lot line......_--------- <br /> n Number of pits---------- --------Lining ma�te_ria -------Size: Diameter.........................Depth--------------------------------- <br /> Cesspool: Distance from nearesf.'well-----------------Distance from foundation--------------------Lining material.._..__....._______........_________- � <br /> ❑ Size: <br /> aterial.........................----------- <br /> Size: Diameter--------------------------------------D pth -------------- ------------------------------Liquid Capacity-------------------..----•--gals. <br /> Privy: Distance from nearest well------------- -------L-..rj---------- -------Distance from nearest buildin❑ g-------------------------------- -------- <br /> 0, sf lot line-------------•--•-------I------- ---------------------•-•-----------------------------••----•--•---------------•----•--•------.------------ <br /> Distance to nearest <br /> Remodeling and/or repairing (describe):------------------------------------ ---••---------......--------------••-------------- ------- --------------------­I.........---------..----- <br /> IK ------------------------------- <br /> ....................................................­---------------------------­­------------ -----w----------------------------------------------------------------------------.......---- ------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------- ------­---------•----------------------- ------- <br /> ----------------- -------------------------- -------------------------------------------------------I-------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that)I have prepared this application anST*aNN;'Wqrk7v�'111�be done accordance with San Joaquin County <br /> ordinances, State laws, an rulend regulations of the San Joaquin Local'149alth District. <br /> (Signed)--- x- ---- ------ ------------------------------------------------------------------------(owner and/or Contractor, J <br /> -1�2 -- ----------- ........(Title)---------- ----------------- --------------- ---- -------------- <br /> e_1----------------------------.................... <br /> By:........... .... ... i i-ion � <br /> i�' f system in relation to wells, buildings, etc., can befild6eil on reverse-side]. <br /> (Pf6t p"lan, showing isi 041.lot, loc- tio Q system in <br /> FOR DEPARTMENT USE ONLY <br /> 7_ <br /> APPLICATION ACCEPTED:BY--------- ------ ---------------------------------------- ----------- DATES---- �=� ` ��` ------ <br /> REVIEWEDBY----------------_- ----------------------- -------------- ------------ ------------------------------- --------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------- - __—-------------------------------------- DATE ------- ----------------------------------- <br /> Alterations and/or recommendations—.SEP—_ T1.0#4 10-P....ZO-r—A-T W-49. ......A191C1<_1---------- <br /> ------------------------ ------- --------------------------------------------------------------1-----------------------­-----I.............. ..................•'rA.!;;k............... <br /> -----­-­---­------------- ------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------­----------------------- <br /> ----------- --------------------------------------*------------------------------------------------- <br /> ----------------------------------------------­­----- .. .... <br /> ------."--------------- -------------------- ---- ---------- ------ .......... --- ------ - -- <br /> 67 <br /> FINAL INSPECTION - -- ---- Date------- A3-------­-­ ---------, <br /> -------------------------------- <br /> SAN JOA , IN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED d-551 2M 5-6t AILAS <br />