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FOR OFFICE USE: <br /> -LQ_-ll.�; - ---— - - -- - V �7 s <br /> w APPLICATION FOR SANITATION PERMIT Permit No. os ot_�------`_-- <br /> m- (Complefe•in Duplicate) <br />------------------------------.-__---_.._.---------------- This Permit Expires 1 Year From 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 comliance with County Ordinan No. 549 <br /> (3�'= � --- - °�`C�_ - --'- f"- J -•---------------------------- _ <br /> JOS ADDRESS AND LO TION.-- r.:-- `--"-� s, 1 -- -------- -- - ---- Phone---��� �i'�-� <br /> Owner's. Name--" C- C_ _ l-{___, _�. ; 99yy <br /> ____._ __. ____J__________________________________________________ <br /> Address-------------------��� �-� -------�--'--_�'.�_�-:: - - - -- --CQ- - ----- ---- <br /> aof <br /> Contractor's Name--------L:-_� .:._` •�:�-1c�;A.�fC�l!vte 1. --- -- ------ / !._ --rf,1_- <br /> Phone_ _._- <br /> Installation will serve: .Residence ❑ Apartment House ❑ Commercial ❑ Trailer Gemilif JE Motel <br /> f❑ Other ❑ <br /> Number of living units: 1_- Number of bedrooms !2__ Number of baths 1._._ Lot size ------ �'�-��-r----------------------- <br /> Water <br /> --------=--Water Supply: Public system ❑. Community system ❑ Private ® rDepfh to Water Table/ S,ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam jfl Clay ❑ Adobe ❑ Hardpan ® N, <br /> Previous Application Made: (if yes,date_. ... ........_..- J No ❑ New Construction: Yes 'P-No ❑ FHANA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! r O <br /> Septic Tank: Distance from nearest well____ _ CJ-r-.Distance from fQuDd tion_.._ _..____Materiel ___: ? rte~_______ ._ ._ . <br /> No. of compartments_..-_...__,�_.s___-....Size__A�2-t__ _ "7�1Liquidf�depth....-SO..... ........Capacity___ j <br /> Disposal Field: Distance from nearest welt_-- '.�.._Distance from foundation-_-. �3.---------Distance to nearest lot line-/S--------- <br /> .. <br /> If <br /> Number of lines__ Length of"each ------- ___--. Width of trench... _�j�_ <br /> • '{ J <br /> rt �� fir------------------ � <br /> Type of filter material___! _ _ -_ tti Depth of.filter mater�31____ ________-_Total length_...__ ..1�_G�_________________________ <br /> Seepage Pit: Distance to nearest well.................. ...Distance from foundation--------------------Distance to nearest lot line__.__._.__..____. <br /> ❑ Number of pits--- ---------------...Lining material---------------------- Size: Diameter---------- ._.Depth---------..---------------------- <br /> Cesspool: Distance from nearest well ________________Distance from foundation----------------- ..Lining material-_----------------------..-____.__-__. <br /> ❑ Size: Diameter. . --------------Depth-------`------------- ------ - - - ----------------Liquid Capacity- . --------------------gals. <br /> Privy: Distance from nearest well----------------------------_----_----------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot-line- i _-----------—------ <br /> Remodeling and/or repairing (describe):v._ ___U '_!- _ -- _____________ <br /> ----------------------- -- -------- ------------- <br /> ---------------------------•---------------• - •-------------•------------------------------------ --•:-- -------------------------- <br /> - ----------------------------------------------------------- - <br /> -------•----- ------------------------ --------------------------------------------------- --------------------------------- <br /> n <br /> I hereby certify .that 1 have prepared this-application'"Sind 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 /> (Signed)------ �''�12 � ��------------- --------- - - - -------------------- --------------(Owner and/or Contractor) <br /> By:---- — C� ­-------------------------------------------------- -------------(Title)---------...------ ---- ---... ---.---- . .._....------. --------- <br /> (Plot plan, showing size of Iot, locat' n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY /� -7 <br /> APPLICATION ACCEPTED BY------- ...... ------------------------------------------------------- DATE----/ f l <br /> ----------------- <br /> REVIEWED BY-------------------------------------------------------- ------------------•----- ------ DATE---------- •----- <br /> BUILDINGPERMIT ISSUED-----•-- -- ------- ---------------- --------- ----------------------------------------------------- DATE--------- - ------ ------------------------------------------ <br /> Alterations and/or recommendations:----------------- -------------------------- ------ ----------- ------------------------------------------------------------------•--------------------------- <br /> --------------------------------I----- ------- -------------------------- ----------------- ---------------------------------------------------------------------------•-- ---- -----------•---.-----•--------------- <br /> ----------- ---- - -- - - ---------- -------------------------------- ----------- ----- -- ------ - -----------------------------------------------............................................................... <br /> FINAL INSPECTION Date.... ------------ <br /> 04 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 WestOak'Street 124 Sycamore street 205 West 9th Street f <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2)45 1-67 Vanguard Press <br />