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APPLICATION FOR SANITATION PERMIT Permit No. ._ 4...'. af <br /> ----- --- - - ------- ------------------- ----------- (Complete-in Duplicate) —� <br /> Date Issued <br /> __ I This Permit Expires 1 Year From Date Issued <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 /> � <br /> JOB ADDRESS AND LOCATION--•- ---- 9 - w, .-----wh�slwf1jG��✓._�S_'�BG��A1 ----------------------- <br /> Owner's Name------------------'(--- 1-&AI-------- _ _. .N7-------- ------------- Phone-- <br /> Address--------------------------- -- oqq[-Y ----_e_,5_21.11 4-------fir AW-1_ty - 57 �" �r`'� --_----------. - <br /> Contractor's Name------ A- R__ --- <br /> 14-- -----�i'---=--50N .5- - ----- -- ----------------------------- -------------- Phone 44k,k F/p,P7------• s} <br /> Installation will serve: Residence E] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other )Q 5-.j0"GeAGE <br /> Number of living units: -- ----- Number of bedrooms -------- Number of baths.-------- Lot size _____ ___ ________ ________ ____________.___________.._.__ <br /> Water Supply: Public system P( Community system ❑ Private ❑ Depth to Water Tableo?Q- ft <br /> r <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------.------------ ) No New Construction: Yes No ❑ FHA/VA: Yes ❑ NoSK <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: T <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 <br /> Septic Tank: Distance from nearest v elS�WC-7Distance from foundation___ Q_.-.___-_M^aterr�I ___ p/1/.O�r _] ^_..._. <br /> No.,of compartments_..._ ...______..___Size_S-X.?------ -----------Liquid depth__-_Z.___.. ........Capacity_.$QQ_6-4-4 <br /> Disposal Field: Distance from nears well:f.VC/4E Distance from foundafion__(O...----...Distance to nearest lot li e___ ---c- <br /> Number of lines__ ________ ______________Length of each line__ _,__-_________--_Width of trench._z _______.._.___..._-____. G` <br /> Type of filter mate ria l--,P,.DC--------Depth of filter material----1_1911---------Total length._/alo----------------------------- l <br /> Seepage Pit: Distance to nearest well-----............-.. Distance from foundation---------------------Distance to nearest lot line-------------- -- <br /> ❑ Number of pits--- ------------------Lining material-----------.------.-- Size: Diameter-----_----------------`Depth--------------------------------- <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]:....+ E-w------�V0--_CZ)-----A4J}_a-_____ .__!_�, __ <br /> ---------------••-•----- ----------------------------------------- WJC 1.11.1 T -_—wur ------Q/Y- 1 1�r r ti-^r-Alli/ -. /�S�l/!1�r-6��1f <br /> -----------------------------­-------------- --------- -----------------------------------, Q - ' ,tel /v1 ----�&I-4----------------------- ------ --------------------------------------- <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) 4�.-PL� - --------------•- ------------ - - ------ - (Owner and/or Contractor) <br /> H. <br /> By:----------------- ------------------ (Title) f �. --------- - - -------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pla dL� on reverse side). <br /> FOR DEPAR ENT USE ONLY <br /> r � <br /> APPLICATION ACCEPTED BY---- ------- -------- --- ---- --- ------------- ----------------- DATE-------- ------------------- it <br /> REVIEWEDBY ----------- ----- DATE---------------- ---------------------------------- - ----- <br /> BUILDINGPERMIT ISSUED-------- -- --------------- ---------------------------------------------------------- - - - ------- DATE----- ----------------------- - ---------- ------------------ <br /> Alterations and/or recommendations:/!-._.7,�--/Y -------NU!h6 I <br /> --- --------------- <br /> --------"A s. e ------- <br /> 6 ---------- e '_C1---- - --- /,- -- --------- <br /> ------ --- ------------ -------- ---------------- ------------------ - -------------------------- -------------------------- -------------------- -------------------------- <br /> -------------------------------- ---------------- ---------- ----- -- <br /> FINAL INSPECTION BY:. - -------------------- bate . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ^'4 <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 vanguard Press ' <br /> �r <br />