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FOR OFFICE USE: <br />------ --------------- -- ------------------------------ No. <br /> 'APPLICATION FOR SANITATION PERMIT Permit ....................... <br /> ------------ ----------------- -- ---------------- <br /> ------------ (Complete Duplicate) <br />-------------- ------------------------------ Date 1�64 <br /> -------------------- --------------- - 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 b,dinanc6' No�,. 549, 4jsjrj-. 2_e) 09C-1 2- <br /> J08 ADDRESS ANDD] <br /> ND LOCATION, --------- -- ------ <br /> t/ S , CC7 <br /> - ----- - ---- <br /> Thone...... <br /> Owner's Name----_--Q/ -------R-•-------- - _W-------- <br /> -----------I----------------------- -------- <br /> A440 f�::701 <br /> :---------------------------------------- --------------------•-•---•--------- <br /> Address------- i...... ..7 <br /> Contractor's Name--------CA__FCT_j__Z--------------------- --------------------------------------------- -Phone.. ... .... <br /> ------------------------------- <br /> Installation will serve: Residence Aparfni'ent House E] Commercial E] Trailer Court El Motel 0 Other L] <br /> Number of living units: -------- Number of bedrooms,?---- Number of baths Lot site ---- ------G_OA_j�--------------- -------------- <br /> Water Supply: Public system El Community,system E] Private 21 Depth to Water Table <br /> Character of soil'to a depth of 3 feet: Sand X Gravel El Sandy Loom E❑I Clay Loam El I Clay E] Adobe 0 Hardpan F] <br /> PreviousApplication Made: (If yes,date-----------:--------) No �ew Construction: Yes El No [Z--THA/VA: Yes E] No 2-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> -or,cesspool-permitted pv— <br /> (No septic tank -permitted if_ 66c.sewer.is available-within 200—f feet.}.. <br /> Septic Tank- Distance from nearest weh,-.0 _._Distance from foundation....../P------Materlai------------------ ------------------------------ <br /> C_ No. of-compartments--------- ----- -.Size----------- --------------------Liquid depth------- ---------- Capacity_..-- ---------------- W <br /> — <br /> ---- Distance to nearest lot line <br /> Disposal Field: Distance from nearest well­__!,;� -'Distance from foundation----- ....... <br /> �Tc------ Width of trench-____-: ---------------- <br /> yX\�5TJ hJ G. Number of lines----------/---------------------Length of each line_____ I-(------ <br /> 1�.IP P Type of filter material--- of filter material-------1-7-_-__----Total length-----------------f? ---- <br /> -st well.... ion-----J-0-------Distance to nearest lot line__��.Seepage it: Distance to nearest _'_-Distance from foundat <br /> Size: Diameter.-.3--v�- Depth____-...-,7-------I---------- <br /> Nu..mber of pifs---------(-----------Lining material__-ROC ---Depth d <br /> Cesspool: Distance from nearest well_____-:-----------Distance from foundation-------------------Lining material ------------------ <br /> s. <br /> El Size: Diameter----- --------------------------------Depth_-------------------------------------------- ----Liquid C6pacity---------------------------- al <br /> Privy'. <br /> Distance from nearest well--------------------------------------------------Distance from nearest building__--_---__-_._________- --------------- <br /> . 0 "Distance to nearest lot line---------------- ------ ------------------------------------------------------------------- -----------r---------------------- ------------- <br /> Remfoi�deling and/or repairing (describe)--------------------_-----_--r------------------- ------------------------------------------------------------------------ -------------------------------- <br /> -------------------------------------------------------:----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ <br /> ----------------------------------------------------------------------------------- <br /> ----------------- ---------------------------- ------------------------------------------------------------- <br /> ------------------- <br /> $ <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 an regulations of the San Joaquin Local Health District. <br /> (Signed}_ -------- ----------------I---------- ------------------------------------ ...........(Owner and/or Contractor) <br /> ----(Title):-------_: .--- ---------------------- -------- <br /> By:�_=---------------------------------------------- ----------------------- ---------------------------------- -------- <br /> (Plot plan, sh" n owing size of lot, locatioof system in relation to wells, buildings, etc., can be placed orf"reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------ ------------------- <br /> APPLICATION ACCEPTED BY------- --------­---------- ------------------------------------------- DATE ---- <br /> DATE------------------------------- ---------------------------- <br /> REVIEWED BY--------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------- ------------- --------------------------------- --------- ----- DATE----- ------------------------------ ------------------------ <br /> Alierations. and/or recommendations:__--__-________________--- ---- -------------- ---------------------------------------------------------------------------------------------------------------- <br /> --------------------------- -------------------- --------------------------------------------------I---------I-------------- ------------------------------- <br /> -"-------------------------- -...j >-_ ,- "4 1-'?� .,%--% <br /> - -- -----------------:.................... -----------------------------------------I------------------------------- <br /> ------------------------------------------ <br /> ---------- --------------------------------------------I---- ----- -------------------------------- <br /> ----------------------------------- --------------- ..... . <br /> r------------------ --------------------------------- ------------------------ ----------------------------- ------- <br /> -------------: <br /> 1--------- ---- --------------- <br /> -- ---- <br /> ------ <br /> --------------------------- - --ti---- <br /> -------- - --------------- -- - -- <br /> -7--7 Date------------- ------ ------------------ <br /> -FINAL INSPECTION ...... <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 /> r.P.CO. <br />