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FOR OFFICE USE-:.! <br />-------------------:------------------------------------- <br /> ---------------------- -------------- -- --- -------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. S;.�---- ------- -- ----- ---------------------------------- (Complete in Duplicate) <br /> -------------- ------ ----------- --------------- This Permit Expires I Year From'Date Issued Date Issued . <br /> Application is hereby made to the San Joaquin Loca��Inf4-District for a permit to construct and install the work herein described. <br /> This application is m ade in com Ii nj;j'itk County C ce N o. 549. <br /> IN '407- W 76F 7V��7 . ., I <br /> JOB ADDRESS AND LOCATION--------------------------- .... :j0x_ ---------- ------ <br /> ---- -- ---- ---- <br /> Owner's Name------------ -S Y.R_ Q C,7-10 f%/------- -70-. ------ Phone-9,160--Z�1---- <br /> Address-----------------AjO,-----Box---------------302 Z---------------I-A-T-14-ROP----------------------------------------------­------------------------------------ <br /> Contractor's Name __Fw,__�EK--------_-------------------------------------- ------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence ff"Apartment House 0 Commercial Ej Trailpr Court [] Motel [] Other ❑ <br /> Number of living units: _1.---- Number of bedrooms-3--- Number of baths/ - Lot size <br /> e/ - - ------------------------- <br /> Water Supply: Public system Communit[Gravel <br /> m E] Private E] Depth tb \A�ater Table AV <br /> Character of soil to a depth of 3 feet: Sand F]. Sa0y Loam E] Clay Loam 0 Clay [D Adobe E] Hardpan F] <br /> Previous Application Made: (If yes,date---__._..._._....__1 No New Construction: Yes �o Ej FHA/VA. Yes, No [:] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> -1 �_ ___k <br /> anVor cesspool perm p iE---se -,Witl1i6 20016-6f I`_- <br /> (No septic 't' I 'iff6d-if 'abi wer <br /> Septic TaDk_­ Disfake from nearest well__4�_W----Distance from foundation-_149-------Maferial__CVN!;R_�_TjE-------- <br /> No. of compartments-.------- _ ----Si7e3/Y/4__Y__!5 __Liquid cl,pth_--y, Capacity----- <br /> F <br /> Disposal 5plcl: Distance from nearest well--C.Al---Distance from foundation----ID---------Distance to nearest lot line-----S5--------- <br /> .__ _A /2-: fZ-1/ 3 -------- <br /> Numb;r of lines--- - -/ ----- --------------Length of each lin4f.7A I -_ _ZWidth of trenck......... --6- "' -t------- <br /> Type of filter mcjteriaI__.k0CK,____Depth of filter material...... ---__Total length---------------I-V-15-------------- <br /> Seepage Pit: Distance to nearest weft----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Number of pits----------------------Lining material-------------------- -Size: Diameter------------------.----Depth----------.---------------------- . <br /> Cesspool: <br /> apfk--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--_----------------Lining material---------------._-_.._-_-------------. <br /> ❑ Size: <br /> aterial-- ----------------------------------- <br /> Size: Diameter--_.-------------------- ----------Depth--------------------------- -------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.._-.-...-------------------__-.-.--..-----. <br /> ❑ <br /> uilding------------------------------------------ <br /> El Distance to nearest lot line- - ----------- ------------------ ----------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing..(describe):----------__------------------ ---- --------------------------------------------------- ----------------- -------------------------------------- <br /> ------•-----------------------=-----------------I ------------------------------------------------7---------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- <br /> ----------------------------------------ify that <br /> ---------------------------------------------------------------------------------------------------------------- <br /> I hereby ceffif that I h prepared this application and that the work will be done in accordance with San Joaquin County <br /> ' <br /> ordinances, <br /> St laws, an r es and regulations of the San Joaquin Local Health District. <br /> {Signed y----�_/-: 14------------------ <br /> 4 --------------------------------------------------------------------------(Owner and/or Contractor) <br /> -7 �/ , <br /> -—--- ---------------------------- I...... <br /> y------ ---- -- - ----------- ---- ---- - - ------------ <br /> (Plot plan, showing size of lot, locatio Eof system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE,ONLY­ <br /> APPLICATION ACCEPTED BY_.... -'--------- --------------------------------------------------------- DATE------ 49!5�------------------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------7-----—-------------------------------------- DATE--------------•------------- ---------------------------- <br /> Alterationsand/or recommendations:--------------------------------------------------------------------------------------------- ---------•-------•---- --------------------------------------- <br /> --------------------------- ---------- ------------ -------------------- - -------- --------- - ------------------------------------------------------- <br /> ------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- ------------------------------------- <br /> ------ ----- -------------------- -- ----- ---------- ------------------ -------------------------------------------- ---------------------- ------ -I ------------------ <br /> ................. ----------------------------------- ------ - .................... --- ---- -------- ---------------- -_ -------I-------I- -----­­---------- -----------------------­-- <br /> - --- -- ---------- --- 4 <br /> FINAL INSPEC Date-------- -----7---- -------- .. #-------- ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />