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APPLICATION FOR SANITATION PERMIT Permit No. ... <br /> ---------------­----- ----------------- "' (Completen Duplicate) jd `j'.3 <br /> ---------------------- - _ This Permit Expires 1 'Year Froin Date Issued 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 N6.'549. <br /> i, <br /> JOB ADDRESS AND LO ATION---...... � /_------------•--. --------------------•------•----- <br /> Owner's Name________ <br /> y� "- ,�f './ �--------- Phone. <br /> _ 1 - __ <br /> Q -------•-•--- --- -----------------------------•-------------------------------------------------..__-- <br /> Contractor's Name---L=��1�,00r/ ------ <br /> Installation <br /> ---- � •e �� ""' � Phone 'T-7-1-.7,64- <br /> Installation will serve: Residence ❑ Apartment Hduse ❑ Commercial ❑ Trailer Coact Toe Motel ❑ Other ❑ <br /> Number of living units: 4--- Number of bedrooms __Z Number of baths 1_____ Lot,size -----AA, --------------------- <br /> � p. <br /> Water Supply: Public system.'❑ Community system'❑ Private [rYDepth to Water Table}_..._ _ ft <br /> Character of soil to a depth of 3 feet-. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam j-Clay'❑ Aclobe ❑ Hardpan ❑vy <br /> Previous Application Made: (If yes,date------------------- No e" New Construction: Yes ❑ No P-' FHA/VA: Yes ❑ No [P} .r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:. <br /> a- (No septic-tank or'cesspbol•permi#ed-if public sewer is available within~.200-.feet.l� ° W"y <br /> Septic Tank: Distance from nearest welllk -_--Distance from found tion_ 0___........Material ------�A--- _______________________ � <br /> ®/ No. of compartments_..-_-.A- ---- -Size-----/-� �- {Liquid depth------'�"~.....- --------Capacity______.____________-_-- <br /> Disposal Field: Distance from nearest we1V419t7_-'1"__Distance from foundatlon__�, `___.._.Distance to nearest lot line__-------------- V} <br /> Number of lines----------- - <br /> �-_ L ngth of each lin r :! ��,'__._�F_--_.Width of trench.._._ -------------_-------- <br /> 'M <br /> _____._ <br /> Type of filter materia epth of filter mterial_f__ .-.-___..Total length___.-__ _______ <br /> ------------------- <br /> �. _J ~' l <br /> Seepage Pit: Distance to nearest well_sl� _-.Distance from foundationJ�,h__: "_..Di�tanee' o nearest lot line_J_----______.__ <br /> + timr <br /> [� Number of pits.._ ._1_.__-_-____Lining material._:��4:rf�_ Size:�Diameter.4___A3.-_-_Depth----.._/�Z---------- ---- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation --------------- ..Lining mate rial__-----_---__._____.__._- -_-------. <br /> ❑ Size: Diameter---- --------- ----- ---------------Depth------�;------ -- --- - -—---��-----C Cpd-Capacity- - --------------------.--.gals. � <br /> Privy: Distance from nearest well---_.-_________-----_----_------------ ___._.-.Distance f om nearest' building <br /> ------------------------------------------ � <br /> ❑ Distarce to nearest lot line ....._._ IF: :--,--� ---- - ------------------ <br /> Remodelin and/or repairing describe ----- C�iCIL '- _o`* �----------------------- ---•--- ---- - ------------------------------------ r <br /> ------------------=----------------- --- -----=---- -------- ----------------- ---------------------------- ------ <br /> I. <br /> r� <br /> ------------------------- <br /> -` ="-• ' = `= "---------------•---------------- ------ -------------- <br /> ------------------------------- - <br /> I hereby certify that I have prepared this application and that the work wtll:be"done-in accordance with San Joaquin County <br /> I'E ordinances, State laws, and rules and regulations of the San Joaquin Local Health.Di'strict. <br /> (Signed) L� -1��✓! __ _f v0! --------------------------------- /or Contractor) <br /> ( ) <br /> = <br /> By:-------- <br /> _ ­­ <br /> ------------ <br /> (Plot plan, showing size of lot, to tion of sys relation to wells, buildings, etc., can be placed on reverse side). <br /> i <br /> E: <br /> _.-.:ateFOR DEPARTMENT USE ONLY <br /> v ., E. <br /> APPLICATION ACCEPTED BY-- -_-.--- - �_-- -- - " ----------- DATE---- - -- -------- -- - <br /> REVIEWEDBY------------=------------------ ------- -- ---- -----------_ -------------------------- ---- ----- ------ DATE------------ ------•----- --------------------------------- <br /> _ . - ----- -- - - - -�DAT : - - T - � ------ <br /> BUILDING PERMIT'ISSUED._ -- - rv`- ----- -------- ---- -- -- ---- -- r <br /> .------` '1►, sem- `- <br /> Alterations and/or recommendations----------------------------------------------- - ---- --------------------•- •---------------- -•------- <br /> ------------------------------------ ------------------- - ------------------------------------ ---------------------------------- ----- ------------------­---- --------------------------------------------------- <br /> FINAL INSPECTION BY '�p^ �. Date_... y-----�5 `.� ....................: <br /> SAN JOAQUIN LOCAL HEALTH DISTOCT• <br /> . i <br /> 1601 E.Hazelton Ave. 300 West oak street 1,- 124 Sycamore$treat 205 West 9th Street <br /> Stockton,California Lodi, California Manteca, California Tracy,California <br /> i - <br /> E.H.9 2M 1.67 vanguard Press µ - <br />