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FOR OFFICE USE:'& <br /> ------------------------------I-------------------------- <br /> ---------------------------------- -- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------- --------------I----------" ------------ (Complete i -DU'plicate) Date Issued <br /> ------ -- --------- ------------ ---------- ---- ---- --- This Permit Expires 1 Year From Date Issued ------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her in described. <br /> This application is made in compliance with County Ordinanu UD 549 CARS 0 L___ro" <br /> tjCRt-I q <br /> JOB ADDRESS ANDC�ATION.........1. C------ ......... ---Ali�--------aw-V <br /> LO ---------- <br /> ------ ------- <br /> Owner's Name-------------aac. ....... ---------------------- ------ Phone--------------------------------I--- lu <br /> Address------------------------- •......." /, 15_'�_e i4_L'y�4 {-------------------••-•--------- -------------- <br /> ------------- <br /> Contractor's Name----- ------- D A�_C_ _/e_-_73.iio.C�- --------------- Phone-?V-7-/7 <br /> Installation will serve: Residence � Apartment House E] Commercial [-] Trailer Court [] Motel El Other [I <br /> Number of living units: _1---- Number of bedrooms .3--- Number of. baths Lot size ---- -------------------------- T <br /> Water Supply: Public system [-I Community system El Private_[4 Depth to Water Table ;ii- ft. <br /> Character of soil to a depth of 3 fee+: Sand N Gravel El Sandy Loom [4, Clay Loam [] Clay E] Adobe Ej Hardpan E] <br /> Previous Application Made: (If yes,date___________________] No [j] '.New Construction: Yes E] No E] FHA/VA: Yes Ej No E] <br /> TYPE.OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool p_e'r_m­14te'd if public sewer is available within 200 feet.] 4m, <br /> Septic Tank: Distance from nearest well------------------D i sta kce�fr8 m foundation--------------------Material------------------------------------------------ <br /> 1 -- <br /> n No. of compartments--------------------------Size------ Liquid depth___---------- - ------- Capacity_...------------------ <br /> Disposal Field- Distance from nearest well.. ,570-----Distance from foundation---- ......Distance to nearest lot line.-,,.S-----ff--- <br /> F1 4 GT- Number of lines----------�/---------------------LengfliIof each line---L5_0 Width of trench.-- ---;?,*---------W--------- <br /> Type-of filter material ____Depth.of.fi I ter.,material------ -----------Total length--------- ----------------------------- <br /> Seepage Pit: Distance to nearest well----/_41,0___-_k__Disfante from foundation___._ D,i,fance to nearest lot line--,.S----------- <br /> 0 Number' of pits--- _-____-_____Lining-mate riaI_4,r'__Fii0 Size.- Diameter A__.__X....9___.-Depfh--------41-----I------------- <br /> Z2 <br /> Cesspool: Distance from nearest well------------- ---Distance from ,foundation----- --------------Lining maferial---------------------------I---------- <br /> :EJ Size: Diameter----- ---------------------------- Dept h_!�_,----------i-------------------------------:-..Liquid Capacity-_------------------------gals, <br /> Privy: Distance from nearest well-------------I-------------------------- ------Distance from nearest buildin❑ g---------------------------------------- <br /> Distanceto nearest lot line--------------- -------- - ----------------------------------------------------------------------------- ------------------ --------------------- <br /> Remodeling and/or repairing (describe):-------- I_-A-I_ <br /> ------4710 -------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----- -- --------------------------------------------- ----------------I------------------------------------- ---------------- ------------------------- ---------------------------------------------------------------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------- ----- ---------!: I hereby certify that I have prepared this application and that the 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. hY <br /> --- ------------- -------(Owner and/or Contractor) <br /> (Signed)------ ------- <br /> -------------------------------------------------------- ........... <br /> --------------- ---(Tif le)---<�V -C�1___ <br /> —By:--------------- <br /> (Plot plan, showing size of lot, to- i n 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 /> BUILDING <br /> ATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------:-------------------------------------- --------------- DATE----------------------------------------------------- <br /> Alterations and/or re- c ndatns---------------------------------- ------- <br /> --------------------------------------------A--�--�------------------------------------ -------------I--------F---- <br /> ---------------------------------- VT - ✓- - A� - LAIID - <br /> - <br /> -----------------------------or - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------- ---------- ------ ----------- -------- ---- -- - --------------- -- --- -- -------------------w-------------- ---------------------------------------------------------------------------- <br /> ---------------------------------- ---------------- ----------- ------------------ ------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECT --- -------- -- - Date-------- ---------------- ------------"-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy, California <br /> ES 9 REVISCO 8-59 3M 3-'63 F.F,00. <br />