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FOR OFFICE USE: <br /> _ - <br /> ---------------/Zlr% a_ <br /> II APPLICATION FOR'SANITATION PERMIT Permit No. ----------------------- <br /> ---------------------I- <br /> . ._---------6_---------------------------- ------------------------- <br /> (Complete in Duplicate) <br /> -- . .,.�:, ..�.�;�.,�.�. .� ..,.... �, _ .. Date Issued -••�----- <br /> This Permit Expires 1 Year From Date Issued <br /> f-k--P � ��i I-�€�o--o <br /> Application is hereby made to the San Joaquin Local Health District for a permit to c r�struct and i stall the work herein described. <br /> This application_ismade in c� ap nc with County Ordinance No. 549. -�/ <br /> JOB'ADDRESS AND LOCA ' <br /> TION---- -�- 5-�--'----'-�4`?-�.-�--�--�-----�c.S7�_e��4_�---------j <br /> "-- --•-------------•----'---- <br /> Owne�'s Name----- 1I. "Pa, ------- Pho � �.�_ <br /> ----- - ----------------------------------------------------------- --------------------------------------------- <br /> ------------- ------- <br /> Addrss----------------•--. IM ----------------------------------------_.--.-------_---------------- <br /> Contractor's; Name -------------•--•---------------------- ----------------_- -------------------- ------------•--- Phone--------••--•--------•------------- <br /> Installation will serve: Residence 10 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑F'.Other ❑ <br /> i Number of living units. I...... Number of.bedrooms __�J.__ Number of baths o?,- Lot'size --------- ____. -- - <br /> pf Water Supply: Public systemEl Community-system [I Private 4 Depth to Water Table _47._ ft! <br /> Character of soil to a depthtIof 3 feet: Sand E] Gravel [I Sandy Loam�Clay Loam ❑ Clay [Ddobe❑ Hardpan ❑ <br /> i <br /> I Previous Application Made: 'I[If yes date---------- No ❑ New Construction: Yes ❑ No'❑X.` FHA/VA: Yes ❑ No ❑ <br /> f TYPE OF INSTALLATION AND SPECIFICATIONS: ^- - �^ <br /> i(No septic tank or cesspool permitted if public sewer is available within 200 feet.)t i -- I <br /> 11 <br /> Septic Tank: Distance from nearest well__5v-----Distance from foundation____- . .__--MateridlT__...-­­ <br /> compartments--_- -_-.--_.Size-__.`3- V-6X-- Liquid de th__�_��'` -----. '--Ca acit <br /> oral Field: Dotancel t �W G P• [ P Y <br /> l Disp from nearest well.__ `{ --Distance from foundation---_f-Lr7___-_--(Distance to nearest I j line-__----,-----__--. <br /> I�; of lines________ ------------------Length ofreach line ------ ___ _---_-SWidth of trench._.___--._ <br /> 7� r'/ A <br /> ---------- <br /> Number';,!of // f <br /> l ype of filter material_ �_1� p 5 _ 7 / <br /> __._____De---Depth of filter material____._�_�__�_.____.Total len th___.�._. �._--_________________ <br /> ` ---------- to nearest lot line_____.#.--.___._ G <br /> ' # <br /> f ❑ eNumber.�of pits.--------'------------Lining material------€--- -----------•Size: Diameter ------------Depth t � <br /> ---- <br /> Cessp-'001- Distance from nearest well-----------------Distance from foundation---------- --------Lining�material:---__-__-_-_.--.__..---:__------- <br /> ❑l. Size: Diameter-------------------------- -- -------Depth-------=------------ -------- --- --------o---- --Liquid Capacity—_ ------ gals. 1 <br /> Distance from nearest well---_...._--_________________---- _..._.._...__Distance from <br /> nearest buildi gr_.__..____.___-____-t___-- --------- <br /> Priv <br /> l Y (' Distance to nearest lot line..............____________.______ <br /> ❑ -- <br /> Remodeling and/or repairing (describe)--------------------------------------------t----------•------------------------ -------------•--------------------•--• ------------ ------- <br /> -------------- <br /> -------- -- ---------------------------- <br /> f---------------------------------------------- <br /> ---------------------------------------- <br /> ----------------------------=--- --------------------------------------------------�------------------------------------------- ' <br /> '. ----------------------------------------------------- <br /> -- _ -- -----. <br /> k <br /> 6h ------------ --- --E --- - -- - ------------------------- ----• -- ----------be done In accordance with San Joaquin C <br /> f= ereb certifythat I have prepared this application and that the work will' oil <br /> ordinances, tate laws, d'rul d regulations of the San Joaquin Local Health District. <br /> 1 -------_- .(Owner Con <br /> {Sign ------ <br /> - -- -- -�----'------------ - --. Ow and/or tractor <br /> f y ;w7ingsize of I'"-------• ------- ---- - ------------ - ------------------------ ---------(Title)-------:---------- --- - -------------- ----- --'-----�---- <br /> r <br /> h (Piot ' t, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> I � <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDI BY - - -------- ----- ----- j-------------- DATE ...... <br /> REVIEWEDBY---------- -•----------------' --- ------------------------------------------------------------I-------------• DATE------------- -------------------------------- ........ <br /> 1 . <br /> BUILDING PERMIT ISSUED' ------------- ---------------------------------------------•----------- --- <br /> _ DATE' <br /> Alterations and/or recommndations:.....:.... .......... .. I <br /> e <br /> Iit -------------I--------------------•-------- -----•--------------------------------------- <br /> 5 --------- <br /> ------------------_----------_____!-._--.------____.__._._.___.__.______...._____;__.._.__.....__.-.___..._._.___.__.____-..____._____._._._..-----__------------.___--._._.----....--_----------_--._____-_..__-_- <br /> - ' <br /> I <br /> I .�. <br /> FINAL INSPCTION BY � Date-------�----.------,------'-• ; - <br /> ---- ------'----'- '--_. <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> j 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br />