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-------- -----FOROFFICE USE: , -- -- - <br /> ------------------- --------�--.-_.--_ --------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> - - _. (Complete in Duplicate) <br /> --5--- -- --Tan------:`--'�- This Permit Expires 1 Year From Date Issued Date Issued 1 =__c �-6 � <br /> Application is hereby made to the San Joaquin Local Health District for r I t woj_ ` l <br /> PP Y q permit to co strut and install t e wor ere n described. <br /> This applicatI ,is ade ' ` lianc i h County Ordinance,,No. 549. C7L) � ,��`! y.x,,,_-I, <br /> JO SAN TfON_ __ 1 °-1 neL1�T"RaP <br /> 1 J , i <br /> Owner's Na <br /> r = ----------------------------------------------- --- --------- <br /> Address--- ---.•'3--0d <br /> -------------- <br /> Contractor's Na - .1.� iLrj'_44- 51 � --------------------------- Phone...0__Z'6n! <br /> Installation will serve: Residence [4- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: l f <br /> ______ Number of bedrooms _ _._ Number of baths ___?CLot size ____. _�__._�_1_:��r____________________ <br /> r <br /> Water Supply: Public system ❑ Community system Private ❑ Depth to atet. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardp n ❑ <br /> Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ' to ❑ FHA/VA: Yes No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No_septic:tank.or-cesspool-permit#edrif bii -sewer=is available'within=204 feet:)- r — _ - - _- ---}� <br /> Septic Tank: DJ stance from narest ell ..___Distan�� fro fo nd`�ion-_.L -- ._._..Mat riaL__ <br /> ----- ----------- <br /> e �igg <br /> No. of compartments.___ _________________Size _ _1�._ _ Liquid de�th_ ___....___._.__Capauty_ • <br /> Disposal Field: Distance from nearest well�,�_..�._--.._-Distance from foundation--- Distance to nearest lot line--- <br /> Number of lines______ _____ __ ____Length of each line-3. Width of trench-- �` <br /> E ............. {, <br /> T e of filter materia '� ---Depth of filter materia I <br /> _ yp P �� -To+al length t 41' '!Seepage Pit: Distance to nearest well--- -__- -.=--------------Distance from foundation____-_-----____--__Distance to nearest lot line--._ /-�_ElNumber of pits.--------".-----------Lining material---------- --- - ------Size: Diameter----.------------------Depth--------_- -----------.---------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.__--________.__-_.Lining material-_-._--_._-___---------.------------ <br /> ❑ Size: Diameter Depth Liquid CapachY--------------------- gals. <br /> Privy: Distance from nearest well----------------:-:--------.----_----------- -__Distance from nearest building---------------------------------------- <br /> r <br /> ❑ Distance to nearest lot line------------------------------- -------- <br /> � FRemodeiing and/or repairing (describe);____---._"----'--+._.-----__ -__<_-------__ <br /> „ <br /> 1 <br /> ------------------•----•-------------•-------- ----- <br /> ______________________________________________ ________________._-----.-__------_---...-__---__------.---_---__----__----_.-_-----_--___-----_-----------__._-___--_-__-----_---.----_..--.--.--.--_--___._____.____. <br /> I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laaN allagules and regulations of the San Joaquin Local Health District. <br /> 2,y rP no � - I ; <br /> (Signed)------ ------------ ------ - --- ------------ or ontractor <br /> 2915E_Miner:Ave., - NO.fi 3&4 r. ----- --- ----- -- ----t-,S ----------- Title)-----------._ .....---------_----- <br /> �.. L.. <br /> (Plot plan, showing size of lot, location of system in relatio o we s, buildi s, .� c., can be placed on reverse side}: <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -------------------------------------------------------------------- DATE----- Q.�_ ` <br /> REVIEWEDBY------------- :----------------- ------------ ----------------------------------------------------------------------------- DATE - - <br /> BUILDINGPERMIT ISSUED----------------------------------------------•----------------------------------------------------- DATE----------------------------------- <br /> "Alterations and/or recommendations:------------------------- ------------- - ---- - ---------------------------- --------------------------'------------------------------------- -- ------------- <br /> ' ---------------------------------------------------------- ----------------------=--------------------------------- ---------------------------•------------------•-------- --------------------------•------------ <br /> -•--------- ----------- ------------------------M- - <br /> 7-- - <br /> ---------------------------- ----------------------------------- ---------- ----- -------------------------- <br /> ----------------------------------------- -- - --------- - - --- ------------- ------------------------------------------------- <br /> -------------------------------- <br /> FINAL <br /> ------------------------------ <br /> FINAL INSPECTI Date4 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />