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........... <br /> .......... APPLICATION FOR SANITATION PERMIT Permit No. <br /> ................ I-- <br /> ............................ ........­­....... lComplefe-in Duplicate) z9 0 <br /> .1 . Dafe.Issued <br /> ......... ---------- -­­...... ThisPermitExpires 1 Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein clescrilped. <br /> s app 1.c t7.70 6%is made in c iance w' unt Ordine <br /> 1 AA_jNo. 549. <br /> JOB ADDRESS AND LOCATION...._-. <br /> Owner's N <br /> ame........ <br /> ............... ..... . ....... �Phone.............. ..................... <br /> Address....... • ............. ............................ <br /> ............. .......-----------------............. <br /> Phone_XX7-;�--�'Z_rZ'P' <br /> Installation will serve: Residence Ap&tfflenf House E] ?190mm-...e r-c-i-a- _[❑-------------I...............!­*❑............. <br /> Trailer Court Motel ❑ Other ❑ <br /> Number of bedrooms .... Number of baths ��_ Lot size <br /> .Number of living units: ............ <br /> Water Supply': Public system El Community System'n Private N Depth to Water Table ..-__-- ft <br /> Character of sail to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam [] ClayX Adobe[:1 Hardpan ❑ <br /> Previous Application Made: (if yes,date..----- ------ N6 b( New Construction: Yes E] No E] FHA%VA: Yes 0 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS.- <br /> (No Septic tank or cesspool;permitted ifbl`c sewer is available within.200 feet <br /> fromcre-Pe— <br /> Distance from nearest w6il. C6 ­.......... <br /> Septic Tank: .....Distance �dndation .......Mate.,rial..........., ...... <br /> No. of comparfments_.__..__....�...... .......Liquid depfH.- ......�Capacity�...0..� <br /> .....J.... I N/� ...... <br /> Disposal Field: Distance from nearest,well_.,37.9....Distance from foundation...L�..........Distance to nearest lot line............... <br /> PL Number of lines....... ....--.Length of each line.. ...._... ...............Width of trench... .....__._, . . ......_.._... <br /> hype <br /> rench... ...__.. . . .........­­ <br /> -Type of filter material,.....__...............Depth of filter material.......................Total length_--- ..........1/..i <br /> ... .................. <br /> Seepage Pit: .Distance to nearest well.-.--.:.....:.........Distance from foulndafion....................Disfance,to nearest lot .......... <br /> ❑ Number of pits.__..............Liming material...................c-- Size: Diameter_-.._.-.............._Depth_.......__......_....._...__-- 1 <br /> Cesspool <br /> ept6................. .......----Cesspool bistance from nearest well ..........Distance"ffom foundation-...-............ ..Lining material.._........._..__._.._....___._...... <br /> Size Diameter. .. .............. ................Depth_............ ------­-------- ........­­­......gals. <br /> wy: 'Dist'ance" from nearest well...._._......................5.......-.-..;Distance from nearest building_.....`...............I.................. <br /> ❑ Distance to nearest lo+.I)'ne.................................••--•-•- ­...............---------........................................ <br /> Remodeling and/or repa;r;ng (describp):.............____.............. ...... .........{..----•------•--•-- --•---........-----._- _---.............. ............................ <br /> ....................­----------------------------................................1.1--l'..,.......... .............. ........................................­­­------------­­ -------................. <br /> ........................................ ..................I.....................­.............. -------------- ....... ............ .................­­...................................... <br /> ------------- ........... .....................--_-_.1-....... ........ <br /> .................................... ............................... <br /> I hereby certify f6if I have prepared Ws appli,caf ion-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. <br /> fk­ <br /> ...................... ...............................{Owner and/or Contractor) <br /> By------------------------------------------------- ..............................................., .............(Title)......................... -----•----....._.......-•-• <br /> {Plot plan, showing size of lot, location of system in relation fo,"weiflsi.§iu;Idin9s,,e_fZ—c-ain-be_plac <br /> ted on reverse side). <br /> FOR DEPARTMENT USE ONLY', ' <br /> 'APPLICATION ACCEPTED ................ 7 <br /> _45�_ -----•-_-••.............. DATE--j.1.1 lk ....................... <br /> I DATE.._.---....---- <br /> DATEBY.............. --- -- ------ ---- --- - .............................. <br /> BUILDING PERMIT ISSUED................................................ ............ ............. <br /> DATE.................................. ....................... <br /> Atteratiibns-and/prrecommendations:......::............­1.......... .......... ...........................-1......_1........... <br /> ---------- ................................ ------- -------- . ..................................... ........­....................... <br /> .............. ........... ------------_11­__*"*"_....1-------------- -------- .....................................�.­................. <br /> T1....... .............._._..___...... . <br /> �-------------- -- <br /> ----------*--------------*---------*------- -------------------*----------- <br /> ............. ------ .......... ........ ------ ........... ................­.......... ................. -------­-­............................ <br /> FINAL INSPECTION By -------- ----- DatplA ............. ............... <br /> ----- - - <br /> SAN_jPiAQU IN-LOCAL HEALTH DISTRICT <br /> 1601 E.Noxalton Ave. 300 West Oak Street -124 Sycamore Street 205 West 9th Strool <br /> Stockton,California Lodi. California Manteca,C"Elifornic Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press '111f- <br />