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'APPLICATION FOR SANITATION Pel(MIT Permit No. . .F£-1.. . <br /> _ . .. (Complefe•in Duplicate) <br /> ... This This Permit Expires 1 Year From Date Issued <br /> Date Issued . .._:_�lr..-� <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�LOCATION <br /> - ---AND LOCAT ON."'...... �O_8....... n-Ze -1.rr -- ......--............................................ <br /> Owner's Name--•. . ......-2C._..-'.1. ................f---------------...... Phone........ ......................... <br /> - <br /> Address..i.l l.....l«/�� i -- - «....... . -�ktl ��i1'Yr-�!� 1�...... -----------------------------------Contractor's Name----(..,$1. �..c.a..e✓..--- -. (vir.2GLG-,F' ................................ Phone.! .' L--- <br /> Installation will some: Residence IR' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> i <br /> Number of living units: .. /.. Number of bedrooms _oP. Number of baths _,l_ Lot size .laQ_X-./�,i. ---.......... <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Tabled'P ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ <br /> Previous Application Made: (if yes,date___..._.._..__ I No ❑ New Construction: Yes ❑ No Q7c FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: C <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> e tic Tank: Distance from nearest well.................Distance from foundation.........._....._.Material .....-___...._---------------------------- <br /> No. of compartments.....-....... -...........Size-------------------- -----------Liquid depth--------- ------- -----.Capacity................. <br /> -..-- <br /> DisposaNField: Distance from nearest well..wSO......Distance from foundation../iO...........Distance to nearest lot line.Z47-0... <br /> Number of lines_.................. ........_.Length of each line_. ....�p..I--- .....Width of trench.....a .11---------------- <br /> Type <br /> -._....------_ <br /> T e of filter materieli.. .. <br /> YP .Q.Ctf.'..Dopth of filter meterlal.....�18.........Total length---------- ..................... <br /> ri r <br /> Seepage Pit: Distance to nearest -----Distance <br /> ..�,from foundation...a`... .......Distance to nearest lot line/ ....... <br /> Number of pits... ..,1........._.Lining material_7f7etne-4 Size: Diameter...',.f...3_.........Depth._..v7.S_................ <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----- .............-.--------- ...... <br /> ❑ Distance to nearest lot line--------------------------------------'--------------------------------------------------.._.----------`------------ _. <br /> Remodeling and/or repairing (describe):.....-........................................ ---.....-'----............--................. <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 /> (Signed)....... tl�i <:--C.- - [...:!ce: .. ....------`----........---------...._.. (Owner and/or Contractor) <br /> r _.. . _..--- <br /> ...........................I ------ ------------ ------.. .....__....(Title)--- ..... ------- <br /> By: _ <br /> (Plot plan, showing size of lot, location of systdm in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- - -._.U-6 vA - ............... ... ---........... . DATE- <br /> REVIEWED <br /> ATE REVIEWED BY.............. ------------------------------------------------------ ----- .................................................. DATE........... <br /> ..----.....---------------........._..... .... <br /> BUILDINGPERMIT ISSUED..------ ------------------------------- ------..........-----......... ---'...... . ......... DATE-------------------------- ................................ <br /> Alterations and/or recommendations:-- ........._. ...-- ..................._..------- <br /> .-------- <br /> .----------- <br /> .---------------.--------------------------..---------'--------------.... <br /> ��) -- .. D�,`, - .............................................................................. -..................... <br /> FINAL INSPECTION BY:....-V.!(-rC. .�^'4.v........... ....._... Date...z/ 7. .6. -.................--........................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1.Massillon Ave. 700 West Oak Street 124 Sycamore Street A 205 West 91h Street <br /> Stockton, California I-adi California Manteca,California Tracy, California <br /> E.M.9 2M 1.67 Vongvard Press <br />