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_..- _....... ..... . _.___ ..._..---. . APPLICATION FOR SANITATION PERMIT Permit No. .cf.x7sT.....! <br /> - --- (Complete-in Duplicate) Fj J[ <br /> This Permit Expires 1 Year From Date Issued Date Issued -_ ! - _ . x <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 application is made in compliance with County Ordinance No 549. <br /> JOB ADDRESS--A.-f-Nj fD LOCATION-------- <br /> Owner's Nam .T-_`✓ -=-:- <br /> Phone...'J_l_T_ <br /> - -- - <br /> Address...... ..... ---- <br /> 1-1 <br /> Contractor's Name--------------- --&- --------- Phone-------------------------------- <br /> ' <br /> Installation will serve: Residence U41"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I <br /> Number of living units: __f_._ Number of bedrooms _Number of baths I... Lot size ----A-CR.E_q-Z--._.____-_---...._.-._ <br /> Water Supply: Public system ❑ Community system [I Private Depth to Water Table h__ . ft <br /> Character of soil to a depth of 3 feet- Sand JrGravel ❑�,/Sandy Loam ❑ Clay Loam Ey Clay E] .Adobe E] Hardpan <br /> _ _ _ Ll <br /> Previous Application Made: (If yes,date ..... _-, <br /> ...-. I No New Construction: Yes ❑ No 0�7FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1 <br /> Septic Tank: Distance from nearest well_.t1.P.__....Distance from foundation.h_----------------Material .'..O�V.�.f'�..E.x. ......_.___._ <br /> 0 ji$ f compartments---- ------- __-Size-----J_A--- __ ___________Liquid de th_.__^ Capacity <br /> Disposal Field: Distance from nearest well--4'.P--------- from foundation...IV..._..._....Distance to nearest lot line__2.Q....... <br /> Q" Number of lines_-_ --------------- -_...__.Length of each line._ -,_g JL-------Width of french-:/# __..-..._...... <br /> ... <br /> Type of filter material-R.O-O ---------Depth of filter material_./.q----------------Total length.-.1../_ry--------------.___.__.__..._ <br /> .Seepage Pit: Distance to nearest well.-I-A:6---------Distance from foundation._(_9.�.__.__ Distance to nearest lot line_7/T`__--.__, ^ <br /> 0 Number of pits._I_____....-_.__Lining material._9-GLC___ Size: Diameter-fl(_.$__...._ De tli.. �p J..-__....._.___.__..._._.':. <br /> Cesspool: Distance from nearest well ..--------------Distance from foundation-------------Lining material----------------------------------- <br /> Size: Diameter- -- --------- ----- ---------------De th.-_------_----------------_---------Liquid Capacity gals. <br /> Privy: Distance from nearest well _ ---_------- ----------_..................Distance from nearest building---------------------___------- -. . <br /> Of Distance to nearest lot line----------------- ---- --------'-----------"/J------------------------------------------------- — <br /> -- -- <br /> Remodeling and/or repairing (describe):----.---- G ---- -. ._- Y !LL!----.-`--- ---.. .--_.--. <br /> ------------ <br /> ---------------------­-- --------- <br /> --------- - . - - <br /> -------------- -- <br /> ------- ' ------i-----------'--'--------------.._.....-`------------------------_.--------'------------------ <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 Joaquin Local Health District. <br /> .t ---A� <br /> (Signed)- ---- ' - -27".--------_..F :��% '----"" "J�t- -- ... ...... . -------------- --------`---------- ---------........(Owner and/or Contractor) <br /> By:----------------------------------------------------------------------------------------------- ------------(Title)---------- ------ -- -- ------ ...........-------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- c R- -- ----- ------ ------------------------ -------------- DATE---- ------------------- <br /> REVIEWEDBY--- ------------------------------------ -- ------------- ---------------------------------------- . DATE---- '-------------------------------------------------- <br /> BUILDING PERMIT ISSUED........ _------------------------------------------------------- ----------------------------- DATE..---------------- <br /> ----------------------------- <br /> Alterations and/or recommendations:---- --------- ------- ----- - ---------- ------------------------------------------------------------------------- ------------- ...... -- <br /> ------------------------- ----------- -------------------------- ------ ------------------------------------------------------- <br /> ----------------------------_ ------------------------------ <br /> ----------------------------L - -- --- <br /> -- - - -- -- - -- <br /> ,n <br /> FINAL INSPEC � !J Date -- _ - ----- -- - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasidism Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Callfarnia Lodi. California Manteca,California Tracy, California <br /> E.H.9 2M 1.62 Vang.ard Press <br />