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FOR OFFICE USE: <br /> -----------------=----------_-------------------------- <br /> -.--- APPLICATION FOR SANITATION PERMIT Permit No. <br /> -----­­-------------------------- (Complete in Duplicate) r <br /> ---------------- This Permit Ex ires 1 Year From Date Issued Date Issued .....z <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'Counfy Ordinance No. 549. <br /> 1 �,� <br /> JOB ADDRESS AI LOCATION_-�� -�e+._e!MP__if`-----U-�I Dt----- a�C " f ....... ��' Tv--'-- I <br /> )?;,I/Owner's Nam &ANUE.L------.1 VI�i ` ...-------•-------- <br /> Address B-�------------- <br /> Address <br /> ---------- <br /> Contractor's Name1 ._ .- '------.-- ­-------------------)---------- <br /> Phone.. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --- Number of bedrooms Number of baths ----r-. Lot size --- --------. CRET----------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table --------- ft. <br /> Character of soil to a depth of_3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: � � <br /> (If yes,date--------- ---------) No E] New Construe+IonT'Yes ❑ No ❑ FHA/VA:r'Ye's ❑—N—❑ - <br /> TYPE{OF INSTALLATION AND SPECIFICATIONS: <br /> - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) uy { Y <br /> 5epf' ank: Distance from nearest w eII-- ..--Distan from fount' a#ion Xii�als <br /> `?r x J�✓Y_ Li uid d h ` -1 _" Ca acit <br /> No. of compartments Size } q p. pt Y • <br /> DiI Distance from nearest well-.-. Distance-f�rb "Ffoundation--I!- Distance to <br /> lot IiK----f"-`�'.---._ <br /> Number of lines---------- --- _.------Length of each line- _ -_-------Width of trench-----' -----------_-----.-.-- <br /> --Type of filter materia=--: 24C ------Depth of filter materal - <br /> --------------Total length----___� - ------------------------- <br /> } © Distance from foundation-_- _�J- <br /> Seepag/e f it: 4-Distance to nearest welly--- _---_.-.--- w ___.-..D tan e nearest lot "n f-._ -_... a <br /> Six'e: Diameter....�....t%:_--Depth_-----.-' ---- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material <br /> � ❑ material------------------------------------- <br /> Size: <br /> Diameter--------------------------------------Depth-------------------,-------------------- ._------.-.Liquid Capacity----------------- •--------gals. <br /> r ii ---Distance from nearest building r <br /> nivy: Distance from nearest well------------------------I ---- 9 <br /> - ❑ Distance to nearest lot line----------------------- <br /> ---_---------_---- <br /> R modeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------•---------•-••----------•-•-------•--•--------••--------------------------------------------------------- -----------------..----------------------------------------------- <br /> --------------------------------------------------------------------•------------•-------- -•-----...-..--------..---..-•-------.-...------------------•------------•-------------------...------•------------ <br /> c'+ <br /> 'I`hereby-certify-that I have-prepared his-application-and"fhat fie work w ll=6e-done-in ac ande'44h San Joaquin-County 4 <br /> ordinances, State laws, and rules and regulations of the Sar+lJoaquin Loca'I�Hnalth District: <br /> (Signed) _ _ <br /> �- TGG _ _ - -.. <br /> f �- ----- ------------------�-------------------------------------------- _ <br /> -_(Owner and/or COntraGtO�) -- <br /> _, � _ <br /> (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-------ft1F-j?------------------------------------------------------------------------ DATEE-------I <br /> I <br /> REVIEWEDBY------- ------------------------------------ ------------------------------------------------------------------------------•- DATE-------------------.... <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations----------------------------------------- ------ <br /> --------------------------------------- <br /> --------------------- --------------------- ----------------------- -- - ---------------------------------------------------- ----•--•------­--------------.. ...... ---------------------------------------------- <br /> -------------- --------------------------------------------- ----------- ---------------------------------------------------------------------------------------------------------------------- •------------------- <br /> ------------------I-------------------------- -- ------ ------------ ----------- ------ ---- `----- -- •------------------------------------.....-..----------------------------------------------------------- <br /> FINAL INSPECT1@ Date- 1-_ �b� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> C0-9 RCVIeCO 0-59 r.P.CO.2M 6.60 <br />