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rUKUNICE USE: <br /> --------------------- --------------- ------------------- <br /> ------ -------------------------------------------------- APPLICATION FOP, SANITATION PERMIT Permit No.41e. <br /> ------ ------------------ --------------------------­_­1 <br /> - ---------------- --------------------------------- (Complete in Duplicate) <br /> - <br /> This Permit Expires I Year From Date Issued N Date Issued <br /> of. ( —133-- 3-2 - <br /> Application is hereby rnacle to the San Joaquin Local Heal+h District for a per-it to construct and install the work-herein c1tscribed. <br /> This application is made in compliance with County Ordinance No. 549. r <br /> JOB ADDRESS A44 <br /> L <br /> 0�eTION <br /> -------- ------- ------ -------- - <br /> ------- -------------- <br /> Owner's Name --- <br /> -- <br /> ----------- <br /> -------------------------------------------- Phone <br /> Address-------- <br /> --------------------------------------­-------------------- <br /> Contractor's Name--------Q(>_� AV I---------------------------------- ------ <br /> ✓ <br /> ------- <br /> - --------- - ------------------------------------------------- Phone-- <br /> ---------------- <br /> Installation will serve: Residence dApartment House [3 Commercial El Trailer Court E] Motel F1 Of.her <br /> Number of living units:./.--_ Number of bedrooms ---�_� Number o _ aths Lot size ------q_4_5_t� <br /> ---------- <br /> ----------------------- <br /> Water Supply: Public,.system E] Community system 0 Private Number <br /> to Water Table -------- ff. <br /> Gravel E] Sandy Loam Clay Loam E] Clay El Adobe <br /> Character of soil to a 'depth of 3 feet: , Sand Ej <br /> I _] Hardpan 0 <br /> Previous Application Made: (if yes,date..... ....,_--_.-J No ❑ New Construction. Yes El No El FHA/VA: Yes El No E] <br /> ..TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank'or cesspool permitted if Public sewer is available within 200 feet.) <br /> Septic fik: Distance from nearest-weil--- <br /> ----Distance from founclati n.-.--1 D -------Material---- <br /> ET, No. of compartments----. 3, ---------- <br /> --------------- ---Size-Y---------y ?iqu�d dep.th-----4/-----------------Capacity_,/,9i;qa <br /> Disp;,-�,eld: Distance from nearesf-w6ll-----t$F6 <br /> Numb'er of lines-' / - ' I.---__Distance from foundation-JP-1 r.__.._.---Distance to nearest lot liner.._-_.----. <br /> -7------ ---- ---------Length of each --------Width of trench 7—f <br /> ------- ------ <br /> Type of filter mate -------Depth of fiiter.nn'aterIaI__. length------- ------------------------- -- <br /> I <br /> Seepage Pit: Distance to nearest wellfoundation.------------------Distance <br /> - --------------------------- <br /> ❑ Number of pits----1___' ' -----Distance from founclLion--------------------Disfance to nearest lot line--------- ------- <br /> ---------------Lining material----------------1-----Size: Diameter-----------------------Depfk ----- <br /> Cesspool: Distance from nearest well-----------------Distance from <br /> - foundation.-----------------Lining <br /> ❑ ion_ ----------------Lining material- ----------------------- <br /> ----- --- <br /> Size: Diameter1------------ - - ----Depth---------- - - ----1-_-----------� -­�- Uqu id�Ca pacify - gals. <br /> Privy: Distance from nearest well------------------------------ Distance from nearest building <br /> F1 <br /> Distance to nearest lot ----------------------------------------- <br /> -- --------------------I--------------------------------------- <br /> Remodeling cl <br /> -------------------------------------- f <br /> ---------------------- •- -------------------------------------------------------------------------------------------------------I-------------- ----------------------------------- ------ <br /> ------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------I------------------------------ --------- <br /> --------------------------------------I-------------------------- ! 4 <br /> --------------------•-------------------------------- --------------------------------------------------------------------------------------- <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 J6aquin Local Health District. <br /> (Signed)------------- ____ ----------- ­_Q-------- ------ --------- ------------- --------------------- --------------------------------------- Contractor) <br /> By:----------------------------I--------------------- <br /> ------------------ ------ <br /> (Plot plan, showing size' stem in re at., <br /> of lot, locafio-n"'of system in relafi to 'wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACC PTSD BY---_. ---- ------------ <br /> REVIEWED BY----4f�(I_b ---------------------------------------- DATE------- <br /> - ------------------- ------------------------------------------------------------------------- --------- -------------------- <br /> ------- --------- DATE-- & <br /> ------------- -- ------------------------------------ <br /> BUILDING PERMIT ISSUED % <br /> Alferafions. and/or recommendations:..- DATE------ ----------------- - <br /> ---------------------------------- -------------------------------------------- -----•---- <br /> ---------------==------------------------------------------------------------------------I----------- <br /> ---- -------------------------------------------------------------------------------------------------------- <br /> --------------- ---------------------------------------------------r---------- -- <br /> -- --------- -------- ------------r----- . --------------------------I-------I-------------- <br /> ---------------------------------- ----------------------------I ----------------------------------------------I------------------ ----------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------- ------- --------------- -------i----- -------- - ------------------ -------- --------------r---------------------------------------------------------------------------------------------- - ------- ------------ ------- <br /> FINAL INSPECTION BY:- V Date.- --;2� <br /> --------------- <br /> ------- --- ------- <br /> - ----------------- ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street, 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CS 9 REVISED B-59 3M 3`60 <br />