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FOR OFFICE USE: <br />------------------------------------ f- �Ze <br />-----------------------------ft.0.......... APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ <br /> ...... (Complete-in Duplicate) - Date Issued <br /> ---- ---------------------- --------- ,This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a'permit,fo construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. j;f 0-y <br /> JOB ADDRESS AND LOCATION-'- 094 <br /> Owner's Name- ev------Idge ee,A,­'-w%IeI17...-------------- - ------------------------------------- Phone------------------------------------ <br /> ---------- <br /> Address....... 09r---------------------­­ ------ -­ ------------- ------------------------------------------------------------------------------------------------- <br /> Contractor's Name-------- <br /> ------------+--;- ------- -----­------------------:­----------------- Phone------------------------------------ <br /> Installation will serve: Residence ®Apartment House ❑ COMT'ercial E] Trailer Court E] Motel Ej Other E] <br /> Number of living units: J... Number of bedroomsb <br /> Num er of bathsLot size --------------------- <br /> Water Supply: Public system E] Community system El Private ZK'Depfh to Water Table,.Xrff" <br /> Character of soil to a depth of 3 feet- Sand E] Gravel'E], Sandy Loam lay Loam [-] Clay ❑ Adobe E] Hardpan Ej <br /> Previous Application Made: (If yes,date_-------._.__._._. } No Vr'New Construction: Yes Z-1qo El FHA/VA: Yes Z—No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wek-1/"- '^'Distance from -------- ------ ----- <br /> No.--of compartmerits-,;;Z----------- -------- depth <br /> . -4 ------- --- -- Cap, <br /> Disposal Field: Distance from nearest well---------Distance from fcunclation!ZV----------Distance to nearest lot line.��------- <br /> Number of lines----- -------Length of each line- ------------------Width of trench..,>Z --- ------------------ <br /> I to m I --------------- <br /> Depth of filter --------Total len <br /> Type of filter material r Oerial' <br /> Seepage Pit: Distance to nearest well-----------------------Distance from foundation---------------------Distance to nearest lot line----------------- <br /> El Number of pits._. ...........---Lining material------------- ....... Size: Diameter-----------.----.-----Depth-------------------------- .... <br /> Cesspool: Distance from nearest well ________________Distance from foundation_____.______-____ Lining material_...-__....____....._._______..----- <br /> F1 Size: Diameter- .. ......... ..... -------------_..Depth--------- ------------------------------------------Liquid Capacity- -------------------------gals. <br /> Privy: Distance from nearest well.............................................. -Distance from nearest building____._-_._.___-__._-._--____-_-_...__..._. <br /> ❑ <br /> uilding-------------------------------- <br /> El Distance to nearest lot line-------- --------- -------- - ---------------­----------------------------------------------------------------------------------- <br /> 04 <br /> Remodeling and/or repairing s) <br /> �V- ----------- ----------------------------------------------- <br /> ---------------------------------------------------------- ------=--------------------------------------------------------------------- ------ ---------------- ---------------------------------------------- ---- <br /> - --------------------------------- -------------- -------------I---------------------I---------------------------------------------------------------------------------------------------- <br /> - ---------------------------------I --------------------------- -------- ---------------------- -- <br /> --------- - -- <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 /> -----Y-/--i; � - -------------------------------------­----------- Contractor) <br /> (Signed)--------------------------- ----�rz,4 <br /> By:-------------------------------- ------------ ----- ----------------------------(Title)------674zV7,11A7T,?­ --- ------------- -- <br /> (Plot plan, showing size of lot, location of sysfe; in relation to wells, buildings, etc., can be placed on reverse side). <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �;�:-'Xb�- -------- --------------------------- ---- -------------- DATE-----S77-"-r <br /> - <br /> REVIEWEDBY.----------------------------------------:--------------------------------------- --------------------------------------------- DATE------------- ------------- <br /> BUILDING PERMIT ISSUED-------- -- ------------------------------------------------------------------------------- ------- - DATE--------- ------------- <br /> Alterationsand/or recommendations:---- -- ------ -- ------------ ------------------- ----------- ­----------------------------------------------------------------­------------------------------------ ------------------------•- --------------- ---------------------------- ------------------------------------- ------------ ------------------------------------------------------ <br /> ----------- -----1---------- ------------------------ -- - ---- --- - ---------­­------­-- -------------- --------- ------------------------------------------------------ ---------------------------- <br /> ----------------------------------------------------------------------------------------I--------------=----------------------------------------- ------------------ ------............ ----- ---------------------- ----- <br /> .......................-----.................. -------------------------- ---------------- --------------------------------------------------------- ............... ......... --------------------- <br /> -;7 <br /> FINAL INSPECTION BY:.. -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hosellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />