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"" FOit OFFICE USE: <br /> ---------------= =---------------------- ------------- <br /> ------------------ -------------------- --------- <br /> ---------------------- --------------------------------------- <br /> ------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------ -- ------ ------- (Complete in Duplicate) Date -� <br /> -- - ,Th <br /> " is Permit Expires 1 Year4rom*Date=Issued Date issued _ .____" _ __ f <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the=7 erei� ibed. <br /> This application is made in,compliant �w`.h.County Ordinance No. 549. <br /> � Z�ox '; ui.l t—uc�4 -tg0 <br /> JOB ADDRESS AND LOCATION___ El-HE-90---:--- / K . 0 }_ _..--� ------�f'_.....Q_�.._'_,�R-1,�61------ <br /> Owner <br /> -----�------�5i�� <br /> ' I <br /> Owner's Namef�. = = TR } .a�/�i_ Phone ---------- <br /> Address <br /> -Address= ----` -:.-:_.3W-- -�?6zl------49THR-0 ! <br /> Contractor's Name----�Q�lU.�=--- --------------------------- - ---._.............---. _.. ._.�. <br /> - <br /> ----------------------•------ ----._. ------------• _....... <br /> i <br /> --•---"------------------------------------------- <br /> Phone- <br /> Instal{ation will serve: Residence Apartment House'❑ C rnmercial ❑ Trailer Court' ❑ Motel ❑ Other; (] <br /> Number of living units: _�_____ Number of bedrooms __ Number of baths _ Lot size ---�Q- -2-0 .p-........ <br /> _____ _________ <br /> Water Supply: Public ystem ❑ Community system ❑ Private Depth to Water Table .--5 . tt. <br /> Character of soil to a de th of 3 feet: Sand Gravel Satd Loam Clay Loam Clay Adobe Har <br /> A � ❑ Y ❑ Y ❑ Y ❑ e ❑ dpan ❑ <br /> ' r <br /> I Previous Application Made: (If yes,date____________________} No New Construction: Yes �o ElFHA/VA: Yes ❑ No <br /> t T� l OF'-INSTALLATION`AND;SPECIFICATIONS: i <br /> (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) „tl � <br /> Septic T k: Distance from nearest well--S-- Distanced fro foul, ation____�� <br /> '-.,t,r <br /> No�of-com artmenis__--___'Z.�_-_-__Size..`7 _ --. ......Liquid dept' <br /> -- Ca aci � � <br /> Dispose geld: Distance from nearest,well---S-____.Distance from foundation:..--1a____�__Distance to nearest lot�l'ne--- <br /> N <br /> __. <br /> Number of linesf._._- _ // <br /> Lengtof,each line-- ._ =Width�ofs#ranch -- -----•--- <br /> Type of filter material __-� Depth.of-filter material____-_ _ �A`�---Total .length_ __ ___ _ rn <br /> ....R...,...r..-...�.... ._.f...,�. �.. _ .Biu .auk,,pit % 1 ....__ <br /> _ F A ,.: <br /> Seepage Pit: Numabt eof. nearest ------------------- <br /> - <br /> __;Linin' material <br /> foundSize:tion,_______ Dac�e toDepthstlot line! ---------- <br /> • r I ^,` L. . g �� <br /> ❑ p g ize Diameter____ i <br /> cesspool: Distance from nearest well___-____:__. ._Distance from found ation��,-� p, inin ,me.terial_ 1___ _ <br /> 'e.:` € { <br /> j e p Liquid Capacity----------------------- gals. 'I <br /> ❑ Size: Diameter--- <br /> ------------------------------------------------De Depth -= ----- - LI <br /> Privy:i Distance from nearest well______________ __ _______________-___.____--__-_Distance from nearest building-_ <br /> P ❑ .. .._ _. i -,,.._e . _ -- --------------- - •---- ------------------------------------------ <br /> Remodeling <br /> ".' <br /> Distance to nearest lot Ione - T ---{--------------1. ---- <br /> --------------- ---------- <br /> Remodeling and/or repairing (describe):---------------------------- •-----•--------------------•---------•---------- -_--- - <br /> ---•------ -•---------------•------------------•- - - <br /> iI -------------= ------------'-----------------------------------------=---------•---- •--------------------- --------- <br /> -----------------------------------------=--------=--------•--- •----------•-•------------•---------------- <br /> -1 --�- <br /> ----------1-------------=--------------=-------------- •-------------•---------------------------•---------- --=---•---- •---------- = <br /> I hereby-certify that l have prepared this application and }flat the work will be done in accordance with San Joaquin County { <br /> ordinances, State laws, and rule an regulations of the San Joaquin Local Health District. <br /> _ <br /> (signed) . ----- -- -- - --- --(Owner and/or Contractor) <br /> �- <br /> �� <br /> gY=- ---- --- ---- -- - ---------- -- --- ------------------ --------(Title)----------------------------------------- -- -------------- <br /> (Plot plan. showing siz of lot, location of system in a ation to wells, buildings; etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_____._•'`�T� V............4____________ ____ __ <br /> --►- -- �-------- -- - ------ - DATE........ <br /> ­ <br /> BUILREV <br /> DING,NG P RMIT ISSUED----------•--------A-:-------------�--�-6-�-.� _'----------�------_-=-----------._..-•-----•------- DATE---------------•-----.....-------------•--•-•--�------------ <br /> -- ---- ----- ----------- -- <br /> M ----------- -••----------------------- DATE -- <br /> ` = <br /> Alterations and/on.recommendations -:=.., .----�` _,:,,--= - TiR.a <br /> _--6 VUATF j _T199,UF---- ' ----�----•• 114 5 c 7�`� 5.. t, ..: <br /> ------------- 1~ <br /> = ;A - <br /> __ --------------------------------•------- --------------------------_--------•----------------------------- <br /> ------- <br /> ---- --• ----------- ----- -------------------- ---=------------- <br /> FINAL' INSP <br /> ... Date--•• - ------/---------._��------------------------------------- <br /> t SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t+.,_130 South American Street 300 West Oak Street 124 <br /> Sycamore Street 205 West 9th Street <br /> �JStockton,California lodir Californid Manteca,California Tracy,California <br /> s � <br /> E6-9 AE`- 0.59 r.P.CO.1M 6-6�� <br /> x'u y <br /> ! 3 <br />