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FOR OFFICE /�, SE1. <br />---- ---- -- - ---------------- -- <br />---- Permit No. <br />j <br />APPLI ATION FOR SANITATION PERMIT <br />---------------------------- (Complete in Duplicate) Dais Isstred <br />-----------•-1------ ­­ This Permit Expires I Year From Date Issued <br />---------- --------------- described. <br />— ----------------------------- -- <br />Applic tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br />This <br />Application <br />is made in compliance with County Ordinance No. 544. <br />os— ------.................................................---------------------------•----•-.__---_•__... <br />JOB ADDRESS AND LOCATION ------- - ------ ------ ----- --- Phone.. <br />-----­--------------- <br />�: --- * ------------ <br />J_ <br />Owner's Name--------- V_ ze - -�­­­ ----------- ----------- <br />7. ----------_ :i___Z ........... ............................... .............................. <br />-------- ------ ............ <br />---- ....... -------------------- <br />Address ------- ...... _.e.. � - Phone ------------------------------------ <br />---------------------------------------- ---------- t -1111 - <br />Contractor's Name-------------- --------_------------- <br />installation will serve: Residence Zj"Apartment House [:] Commercial E3 Trailer Cou'h {0 motel 0 Other C] <br />........... --------- <br />P�-__'Number of baths /---- Lot siz'e <br />Number of living units:.____ Number of bedrooms-1� && 11 <br />Water Supply: Public System W'CommurOy system 0 private [] Depth to Water Ta6ie .7a.- ft. <br />-_ <br />Character of soil to a depth of 3 feet: Sand El' G . 'ravel F1 Sandy Loam 0 Clay Loam 0 Clay 0 Adobe Er Hardpan 0 <br />Previous Application Made; jlf yes,date --------------- No 2YNew Construction: Yes 991.0 D FHA/VA: Yes g�lo <br />❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Distance from nearest well. -/ ..Distance from foundation ... t h .............. <br />----- <br />Septic Tank: Distance <br />of cornpartments__,14.� dep ...... ----------Capacity- �� ........... <br />Liquid <br />t lot <br />e from foundat' ----- ev Diktalnce to nearest , ............... <br />Disposal 5ield'. Distance from nearest well_AO,�9 -------- Disf&nc 5�� �7 --------- trench A ---------------_---------- <br />Number of lines / ------------ Length of each line_...__ ---------­ Width of frer- R <br />-- ---- ---- ; ___- �, .1 --------- I ------- <br />.�x------------­ <br />Type of filter me erial../g of filter Jength--- <br />Seepage Pit: Distance to nearest Z from f6d-ndation_..�,/e ........ Distanci§ to nearest lot line --- <br />joe- _-Distance <br />ize- Diameter__ -------- <br />Number of pits ----- / ------------- Lining material__„_1&-*&--S ....... � Depth ­o2 / . G <br />Cesspool: Distance from nearest well ---------------- Distance from foundation ------------------- Lining material ----------------------- ------------- <br />Size: Diameter -------- ----------------------------•Depth --_------------------------ ---------- r ------------- Liquid Capacity_ ------------------------- gals- <br />❑ <br />Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ----------------------------------------- <br />---------------------------------------------------------------- ... ... I ---- -------------- -------- ---------­----­------------ <br />Cl Distance nearest lot line <br />_4 -------------------- 1:*�, ------ �1_ =--••---•---••-------------••- <br />Remodeling and/or reairing (describe): ---------- ;q - - - - . - .. - - ..................... I -------- :---------- <br />------ -----------------_----------- : ......... m ---------------------- ------------- --------------- I ------------ -------------------------------------------- ­----------­------- i ----------------------------------- <br />------- --­------------ I ------------- ----------------------------- <br />---= <br />----------------- I ---------- <br />-------- -------- ----------- --------- 1 .1 ------- --------------------- --- I ............ I --------------------------------------------- I ------------ 11 ------------- _ ----------------------------------------------- I ----------- <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 />------------------- Contractorl <br />(Signed] ............. <br />0 - - -------- ----- -------- <br />------------ -- ----------------- ------ <br />ey:. .... ---------- s, . ze� - of _ .................................. ---------- - etc., c., can be placed on reverse side). <br />.10+,-location-of-syste in-relaflon -to -Wells, -buildings, + <br />(Plot plan. showing <br />FOR DEPARTMENT USE ONLY ------ <br />DATE....... ------------------ <br />APPLICATIONACCEPTED BY --------- -- ---- ------------------------ --- ----------------------------•-------.._.------------------- DATE ...... ...... ......... ------------------------------------ <br />REVIEW By------- <br />WED BY ------------------------------------------------- -- ------------ 1____1 -------- * ---------------- - <br />BUILDINGPERMIT ISSUED -------------------------------------------------------------- — -------------- ------- ---------------- DATE _--------• -------------- ------------- : --------------------- <br />----------------- * ------- <br />Merations,prid/or recommepciations. ------- <br />-�a --- - ------- -- ------ ------- <br />W-------------------------------------- <br />---------- I.,-aJ .- I ' -_ -_ , ------------------------ <br />------ -------- I ---------------------------------------------- I ----------------------------------------------------------------------------------------------------------- I ---------- -__--------- <br />I ----­-------­------- ----------------------------------------------------------------------------------------------- _ ---------- ------------------------------------------------------- ­-------------- ... ...... <br />---------------------------­-- --------- r-1 ---------------- --- ------- ----------------------------- ------------- --------------------------------------------------------------------------------- ----­-------------- <br />- — --------------------------- <br />Date ------ I --------�...�... <br />FINAL INSPECTION BY.J, _ ---- <br />SAN <br />JOA-QUIINI - ”LOCA-L, HTEALTH DISTRICT RICT <br />`1 <br />130 South American Steet 300Wbdak Stree <br />t'7 I ycarnoT* Street 205 West 9th Street <br />Stockton, California Lodi, California Manteca, CaliforniaCYr*CYr California <br />ES 9 REvirEV 8-59 OM 5-61 ATLAS <br />