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FOR pFFICE,USE: , <br /> -- -------- ---- "APPLICATION FOR SANITATION PERMIT Permit No. 62-.1,7 <br /> ---------- -- --- ------- --------- - '�. (Complete in Duplicate) <br /> �� Date Issued <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 Ordinance No. 549. / �� � <br /> f <br /> JOB ADDRESS AND LOCA IIO E ---- - Q_ ______[3----o'TI ------ --�-- - -----�1 _1q_+r rI------------- <br /> Owner's Name i ------------iL _L�_�`7__75E.K---------------------==--------------------------------------- Phone.-----------•-----=------------- <br /> Address-------------- ------ ---a.6.?,2�------_s ---•--- --------IF -------8-D-- -­------------------------------------------ <br /> Contractor's <br /> -.----------------------------------------- <br /> Contractor's Name----0WAIE—P------------------------------------------------------------------- ------------------------------------------- Phone---------------------------------- <br /> Installation will serve: Residence eApartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1____ Number of bedrooms __Number of baths ___f___ Lot size ----A<$ e7-A6_E------------------------ <br /> Water <br /> _______________Water Supply: Public system ❑ Community system ❑ Private 2-IDepth to Water Table -------- ft. <br /> `Character of soil to a deptf 'of 3 fee+: Sand ❑ Gravel,❑ Sandy Loam ❑ Clay Loam Clay ❑ .Adobe❑ Hardpan <br /> Previous Application Made: IIfyes,date....................J No New Construction: Yes ❑ No �FiA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No se-ttc larik or cess ool-`ermtttedTif -ublic.sewer is availakile'Within-200—feet—.)� • - '� -' -�--� - �` <br /> Septic Tank: Distance from nearest we11--------------___Distance from foundation------- .--___.Material.____..______._..___...______________._______- <br /> ° �' No. of compartments--------------------------Size------•--------- ----------------- <br /> Liquid depth______________________ ___Capacity <br /> -----•----- -Disposal Field: Distance'from nearest well---570-__._Distance from foundation-----(4?........Distance to nearest lot line----2 -_._____ <br /> Number of lines-- _-:_1-_...-.-..._ ___.____Length of each line__..✓_..__ _ `e <br /> `��(�� �s�- �-�-�----r-R------Width of trench------���-----------------"-- <br /> 4-- ADP- Type of'filter material___ Q __Depth of filter material------- _._._.----Total length--------1.X------ <br /> Seepage Wit-. Distance to nearest well---�� __.. <br /> .....__-Distance from foundation Distance to nearest lot line---- <br /> / Number'of pits........j---------_--Lining material_ ?Q_C_r _-Size: Dia meter- K-10.-- Depth....1.2--- ------------- <br /> I: <br /> 3 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 /> i ❑ Distance to nearest lot line- --------- --- ----------------- ------- ------------•----•------------------------ ------------------- ----- <br /> Remodeling,and/or repairing (describe)-------------- ----------- ----------------------------------------- ----------------------------•------------------------------------------------------- <br /> - <br /> ---------------•--------- ------ <br /> _ ------------------------------------------------ ---------------------------------------------------------- ---•------=---------------•------•------ ----------------_------ ----------------------------------------- <br /> t <br /> I' <br /> t ---`----`------------7------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <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 /> (Signed)------ ------------------------- ------------------- ---------------- ----------------------- --(Owner and/or Contractor) <br /> -_a- ...r.,- --_ -- — .-.» --- - <br /> -------------------------------- <br /> �- - - --._(Title}- � - _. <br /> i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED-BY---__T._o_R, -t----------------------------------------------------------------------- DATE--------- -^ .:_. ----: --------- .. <br /> l REVIEWED BY------- --------------4DATE_---- ----------- ------------------=------- <br /> -------------•-------------•------------------------------------------------- <br /> 'BUILDING PERMIT ISSUED----------------- ------•--------------------------------------------------------- - -------- ------- DATE---------------------------------------------------------- <br /> Alterationsand/or recommendations---=----------- --------------------------------------------------------------------------------------------------------------------------------- ----- -- <br /> ---------------------------------------------------------------------------------------- ---------- ----------------------------------------------------------------------------------------------------------.-......... <br /> ------------------------ ----------------------------------------- ------------------------------------------------------------------------------------------------------------------- ---------------------------------..: <br /> -------------------------------------- --- - -------- ----------• -------------------- --------------------------------= <br /> -i'--- '----- - - - ---- - --- - ------------ <br /> ----- ----- '-------------------•-------- <br /> FINAL INSPECTI BY 4 11 <br /> �� Date--- -------------3 l,�/.?-----?_�. ------ <br /> SAN <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:eHon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street s <br /> Stockton,yCalifornia Lodi,California-. � Manteca,California Tracy,California, ' <br />