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a� <br /> FrjR OF ICE USE: <br /> ------------ - ------------------' - 8�- <br /> ,,. <br /> APPLICATION FOR�SANITATION PERMIT Permit No. ... ......... <br /> (Complete-in Duplicate) <br /> Date Issued <br />----------- ------------- __ ------------------ <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 tl�"orJc h�rei 1eicrjb <br /> This application is made in compliance with County Ordinance No. 549. W V)- <br /> JOB ADDRESS AND LOCATION----------------��'� _Wwwv----- - ---J'AY l�,6,CJ0/� �/!/-- ..-J AV /;1//x <br /> Owner's Name--------------R{�.7----------k ko�wzv-------------- ---------------------------' ----------------- ------------- Phone---------------- -------•----------- <br /> Address----------------_---------fA-A-f - ' --------------------------------------------------....------------------------------------ •----------------- <br /> Contractor's Name------_-----------110,44 IAl�- <br /> ___ _____ �- Phone---._-.--__ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other <br /> Number of living units: :_ ---- Number of bedrooms AK..,,Number of baths-------- Lot size _.-_-1.- .--/JC-Xd ------------------ ' <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam 0 Clay Loam' Clay E] Adobe E] . Hardpan E] <br /> Previous Application Made: (If yes,date_--._---_ . _-- - ) No ❑ New Constructio :Y No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: �� !� <br /> (No septic tank or cesspool permitted if public sewer,-is available within 200_feet.) - <br /> Septic Tank: t cDistance,frorrl_,•riearest well_ LT�Uistance from foundation_.. ._a. Materi I _-_- <br /> � ,� <br /> No. of compartments-----------------------__Size_ __ �p <br /> �,�`_��_ Liquid depth-------_��_ ----�- -...Capacity----- -- --------- <br /> Dis os Field`.'? 3 tDistance from nearest weil_.__ ;..__�_� iDistance e ford tion__=. _ <br /> -_.Distance to nearest lot line----------------- <br /> I � 1. ��"} ,0- . <br /> Number of lines----------- --- ----- --Lengt.h�o�dach Re-- ------- -- ------- Width of trench_._.___: ------------'---- <br /> -----' <br /> Typ�e of filter material.__,._-„_..............Depth of filter material-----------.------------Total length------------------------------------------ ” <br /> Sepage Pit: Distance to nearest well--___.__-----------'Distance from foundation:--___--------_._.Distance to nearest lot line__._.----------- <br /> - --Lining material-____-- .._._.. - <br /> --- Size: 'Diameter-------.------ -------Depth---------------------------- <br /> ❑ Number of pits--- -----------' ----- <br /> Cesspool: Distance from nearest well ----------------Distance fro m;foundetion... _.___.------- ..Lining material-..-..----------- <br /> 4 f' <br /> F-1 Size: Diameter " Dept----------------' ............... <br /> -- --- ---'-' ----Liquid Capacity-- ------------------------gals. <br /> ------------------------ --E,:....-Distance from nearest building_-----------------------------.._-___..-_. <br /> Privy: Distance from nearest well------------ <br /> ❑ Distance to nearest lot line ------------------------.--- ------ -y---`-------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe---- ----- --------- -- - - ------------- i`" - - -----------------------------------------'------------------------------'---------------• <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 and regulations of the San Joaquin Local Health District. <br /> Si ned ------------- -'------ --------------------• (Owner and/or Contractor) <br /> l %.­ <br /> ----- Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Xr <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B ---------------------------------------- DATE Y ------------- ------------.... �. <br /> REVIEWEDBY------------------------------------------ - -------------------- -------- -------- --------------------------- --------- DATE--- --'-'- ------------------------------------------------ <br />�... BUILDING PERMIT ISSUED-------- ------------ ' DATE----------------- --------'-------------- ----------------- <br /> Alterations <br /> ----- <br /> I Alterations and/or recommendation-4----------- x-------- - <br /> E <br /> '- -- -/,V. . X,�r /_.._../g_ccra _ to .------�-----AM-- ' <br /> -•------------------------------------------------------------------------------------..---------------------------.-.-...----_-------=`------------------------------------------------------------- <br /> •_•_•__-------------------. <br /> �s ' <br /> FINAL INSPECTION BY:.... ..� -'--�/ Date-....... -- --- <br /> SAN JOAQU <br /> IN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamare Street 205 West 91h Street <br /> 1 Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> f. v <br />