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i <br /> 1 APPLICATION FOR SANITATION PERMIT Permit No. 2_6_4_7.... <br /> (Complete in Duplicate) <br /> Date Issued <br /> Applical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. <br /> This application is made in compliance with County Ordinance No. 544. <br /> JOBADDRESS AND LOCATION y--------4---7- 1--A------- -� A---------------------•-----------...---------------------------------------------------- ' <br /> Owner's Name------'A- i- PA-------••-K.P P. Mg.01----------------------------------- ------------------- Phone--------------------------------- <br /> ------------------------ <br /> Address.......... -�`Y! ---------------------------------------•------•---•-•----•--------- -------------------- <br /> _ ---------------------------- <br /> Contractor's Name R R ! S H �1✓ -----•- -------------------------------- Phone-------•--------------------------- <br /> Installation will serve: Residence ar-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel r Other ❑ <br /> Number of living units: --I... Number of bedrooms ___-ZNumber of baths __I___ Lot size __-___x G O <br /> --------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 07?�ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [1---New Construction: Yes ❑ No En- . <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-well-_;______________Distance from foundation--------------------Material------------------.------------------------___-.. <br /> ❑ No. of compartments----- --------------------Size------------------------•------•Liquid depth--------------------- ----Capacity---------------------- <br /> Disposal Field: Distance from nearest well_________________D+stance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of lines-----------------------------------Length of each line------------------------------Width of tren6----------------------------------- <br /> Type of filter material_______________________-Depth of filter material-------.-_----------.--Total length------------.---________----_---_-__-.__-- <br /> Seepage P' : Distance to nearest well-- Distance from foundation----!__0........Distance to nearest lot line...... <br /> Number of pits------__/-------------Lining mat erialffrff'c.A,___Size: Diameter---,?3---------Depth-------2- Q0-______________ f <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__--_-.___._---_----_---__-______-__-. <br /> ❑ Size: Diameter-------------------------- -- ------ Depth------------------------------ ---------------------Liquid Capacity-.--------------------------gals. <br /> Privy: Distance from nearest well--------------------------____________________._Distance from nearest building--------_----.----------i.___.._`--_____- <br /> ❑ Distance to nearest lot line-------- ----------- -------•------ <br /> ----------------------------------- <br /> --------------------------- <br /> Remodeling and/or repairing (describe):__ 0/`fr1, ow � Ci <br /> ----------------- ----- _ ____ � <br /> -----------.............--------------------------------------------------------.------------------•------------------------------------------------------------------------------------------------------------------------ <br /> ------------• •---------------------------------------------------------•----------------------------------•-----------•-----------------•---------------------------------------------------1 -- ----------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------....-------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. <br /> ,tea <br /> - --- ------ ---- Owner and/or Contractor <br /> (Signed ... ( / } <br /> BY� -----------------------------------(Title)---------------------------------------------------------------- <br /> ' location of system in relation to wells buildings. etc. can be laced on reverse side). <br /> (Plot plan, showing sae of Eot, I ca o y g , p } <br /> FOR DEPARTMENT USE ONLY <br /> .� ff <br /> APPLICATION ACCEPTED BY------------------------ --------•----------- DATE------ <br /> BY----------------------------------------------- --- ------ --------------------------------------------------------------- DATE----------- --------••--------------......--•---- <br /> BUILDING PERMIT ISSUED------------------------------------ <br /> ------- ------------------------------------------------------ DATE------------ ---------- <br /> Alterations and/or recommendations:------- ---------- --- ---- --- -- -----------------------------------------------------•-------•------------ -- <br /> -- ----- -----------f ------------- - ----------- -- - ��------------- ---- ---.---- a� <br /> "'. ------------- '"'""�, <br /> `�� <br /> - --- -- --- - --- - - --- - <br /> ------------- ------------- -------------- •---------- • - •--------- <br /> 5 <br /> FINAL INSPECTION `IiY �._-�-- ---- - - ------ Dat --- -_--- <br /> -. - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> •'� FS­9-4M 145446 ATW000 12-54 <br />