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FOR OFFICE USE. <br /> --------------------- <br /> APPLICATIONS FOR'SANITATION PERMIT Permit Na. .. ............ <br /> --------- ------------------------------ (Complete in Duplicate) , &r// 7 <br /> ------------------ Date Issued --- ----------- <br /> ------ -------- ----------------------- ------ This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein cl%cgibed. <br /> This application is made in compliance with Count Ordinance No. S49. <br /> 1UnT <br /> AT,0 01 -7 fi 7/6 <br /> ------- --------------------------------------------*------------------------------------------------ <br /> JOBA ADDRESS AND LOCATIO, ..... <br /> -------------------- Phone....------I—---------------------- <br /> Owners Name_ ------ --------- - --------------------------------------- ------- <br /> Address----------- 10--- -------•'------------------------------------------------------I­--------_----------!­­---------- ----------------- <br /> Cont "e ------- ----------------- Phone--•-•--•--•---------------------_ <br /> ,ractor's Name--- --------------------- -- ------------------ --------------------------------------------------------- <br /> Installation will serve: Residence E-"'Apartment House El Commercial [—] Trailer Court [] Motel [_1 Other El <br /> Number of living units: ---- Number of bedroorns—?----- Number of baths -1----- Lot size 447XP�....................................... <br /> Wat r Supply: Public 9 system [E__`Eommuniity I system E] Private E] Depth to Water Table 1_0 ft. <br /> Gravell [] Sandy Loam [] Clay Loam o ClayE] Adobe Hardpan F] <br /> Character of soil to a depth of 3 feet: Sand E] <br /> i� us Application Made; (if yes,date. New Construction Yes [] No FHA' /VA: Yes [] No <br /> Previo -7-7/7-6-3-- ) 'Nolk"I", <br /> IM <br /> 7 <br /> A <br /> TYPE OF INSTALLATION AND S AFICATIONS: <br /> -(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se �j; an Distance from nearest well________________`Distance from foundation-------------------Material________----_______________:_______________----. <br /> p <br /> -. ---------- ---------- --- ------------------- <br /> No. of compartments-------------------------`Size- ---------------------------- <br /> Liquid depth- Capacity.. <br /> Di s Distance from nearest well._.____`-`-_.-_-Distance from foundation/P______________-Distance to nearest lot line__0------- <br /> R ol Number of iines ----------Length of each line--- 19 4 <br /> 4 1-7 <br /> -----------------Width of trench.-- - - -------------------- <br /> aterial-'_7------- --- - h---- ------- ------------------ <br /> Type,of filter m 11-_K._k----------Depth of filter maferial__/,�r.......:_--Total length------- - ------ <br /> a dation____A� -------Distance to nearest lot line... <br /> 5ee <br /> �pj,r 7 <br /> Distance to nearest Distan om foun Depth---- <br /> Number of pits------1--------------Lining material--- Size: Diameter..... . ..... -- ----------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-------------------------------------- <br /> bSize: Diameter-------------------------------------Dept h------------------:--------------------I--------------Liquid Capacity-----------------------------gals. \J) <br /> Priv'h. . Distancefrom nearest well--.- ..---------i-----------m_--w-.7t-----------Disfance.fro-m nearest building_______________-_____________________-_. <br /> Y' -- <br /> Distance to nearest lot line------------------------------- ---------------------------------------------------------------------------- <br /> Li -------------- -------- <br /> Remodeling and/or re{aalring (desc,r <br /> -------------------------- <br /> --- --- ------------------ ------ <br /> ------- ------- <br /> -------------- -------------- --­------------------------------------------------- ---------------------------------------------------------------------------I------- <br /> k--------------------------------------------------------------;------------------------- -------- <br /> --------------------- -------------------------- ------------------------------------------------------------------- <br /> County <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Sa .,Joaquin ou <br /> a regulations/of e an/Joa uin Local lalion <br /> ordinances, State laws, and rules and iegulations of'ffi L al Health District. <br /> nfractor) <br /> {Signed)----- ........ . - -- -------- - ----------------------- -------------------------------(Owner and/or Co <br /> ------------ <br /> --------------------------------- 7------- > <br /> -------------------------- <br /> . ....... . ........................ -----(Title)--------------------------------------- ---- ---- --- <br /> By:------------- _ _X __ � - ......... <br /> ----------------------------*-------- ----- - - ------------ --- <br /> (Plot plan, showing size of lot, location of system in.relafi*n 4o wells, buildings, etc., can be placed on reverse side). <br /> IP <br /> Ip FOR DEPARTMENT USE ONLY <br /> nn' <br /> APPLICATION ACCEPTED BY- ----------------------------------------------------__ DATE----- Z7776_�------------ ---------- <br /> REVIEWEDBY------------------------------------ ------------------I ------------------------ -------------------------- DATE-----------"---------- I----------------------------------- <br /> BUILDING- <br /> ----------------------------------- <br /> BUILDING- PERMIT ISSUED-------------------- ---------------------------I-------------------------------:----------------- DA-TE------------------------------------------_-_--:------------ <br /> Alterations <br /> ---------------------------- <br /> - .' * - - .11-1.c r- - - " I -----------------------------------------------------------:­------- <br /> ----------- <br /> AlterIns and/or recommend ----------__ ------- ---------- ------- --­-------------------------- <br /> L - !9su_ 7 <br /> ----------------- --------?�le�,__� - 1—---------1------------------------------------------------------------------------------------------------------------------- <br /> ---- ---------- <br /> ----------------------------- ----------------------------------------- <br /> ---------------------------------------------------------- - - <br /> -------------------------------------------------------------r; - <br /> ----------------- --------------- ------------------------------------------- <br /> ---------------------------------_------------------------L-------- ------ .......... ------------------------------- ---------------------------------------------------------------- -------------------------- <br /> 7-� --------------------- <br /> — ------------------- ----- ------------ <br /> FINAL INSPECTION BY;... <br /> SAN-JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />