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f FUROFFICE USE: <br /> - <br /> IZ;?-- <br /> --------------------------------------------------------- <br /> d� <br /> -._--_.__--__ APPLICATION FOR SANITATION PERMIT Permit No.� <br /> I (Complete in Duplicate( <br /> -------------------------------------------------------- <br /> --.--- This Permit Expires 1 Year From Date Issued Date Issued -� <br /> X77 � �o <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construe and install nstall he work her in descr01 ed. <br /> This application is made,in..compliance with Coun Ordinance No. 549. <br /> l JOB ADDRES ND LOCA I N...� _ - J----_-_x-_-_, '. . <br /> y ---------- <br /> AddOwner's Name -------- •-------'- -•-- _-� '`-.._ --------------------------------Phone-•----•---•-- <br /> ress x- IS- -R_ 5 -- ���,�/}, <br /> Cantracfor's Na -g -- ._ <br /> '� It ---- -•-------------- <br /> Installation will serve: Residence [ ►_ f0 apartment House ❑ Commercial ❑� Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -Number of bedrooms --2--Number of baths _�_-.- Lot size -___ .._--- _ <br /> Water Supply. Publics stem CommunitY s sten ❑ Private Dep <br /> th to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loamlay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date..............."" .) No ❑ New Construction: Yes Z?-<o6 FHA/VA; Yes ❑ No ❑ <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {Na.septic_tank or�We poo[ permitted if`pubii sewer is available within 200 feet. <br /> r �nrwe.s snrMew <br /> Septic Tank: Distance from neares~�' Dis ye fr fo ion__ _. Material_ <br /> No. of compartment • <br /> --- ----` S1 C quid dept1.——- <br /> ---Capacity------ <br /> Disposal ieid: Qistan*ce from na earesf weDistante f o m*faundaiion ems.: '— <br /> -dt------..Distance to nearest lot line_-�e__._ <br /> Number of lines t ' <br /> Leng}(, of each line_�_�T_.^ �-- -Width of trench- ' -94-------------------- <br /> Type of filter materiDepth of filter material---- ------ length--------------------- O <br /> ,.Seepage Pit: Distance to neare t well ----------------- to nearest lot line_.-------------- f� <br /> El <br /> s ool; D stab ce f om nearest well-__( <br /> material---- <br /> ---------- <br /> aterial---------- ------------Size: Diameter--:--------------------Depth ( , <br /> C - -----__---Distance from foundation--------------------Lining material------------------------------------- <br /> °" ❑ Size Diameter ----- ----Depth------------- ----- -------------.Liquid Capacity gals. <br /> *Privy,,, Distance from nearest well------------------ <br /> Y`" - Distance from nearest building ---------- <br /> ❑1 Distance to nearest lot hire------------------------- <br /> Remodeling and/or repairing fdescribe):--------------- -------------- --------------------------------- ----------------------------------------------------------- <br /> -----------------•------------------------------------------------------------- --------- --------- ----------------I' <br /> AI <br /> ------------------ <br /> ----- .ice} <br /> - ---I <br /> .� <br /> ----- .� : <br /> !°hereby certify that I have prepared this application Ind fhat the work will a done-ln accordance with San Joaquin County <br /> (ordinances, State lavand rules and regulations of the San Joaquin Local Heal! District. 6 A_ <br /> Jh.a <br /> (Sign ed)----------�1a .�r' Ali --------------- t j <br /> IZPTIC TANK�SERVie _ ( ' - �Contrac or <br /> 9I E:iiler�tve:j HOr 6Y38�4i ------ - Title---- - <br /> ---------- <br /> [Plot lan, s awing:size:of,;lot,rlaca#ion ofrsystemrin,relation�to. ells,.buildings;- tc,-can be placed on reverse side}. <br /> k <br /> FOR DEPARTMENT USE ONLY <br /> APPL11CATION ACCEPTED BY.. _: / <br /> ------------- -- --- ----------------------- DATE---- = �- ----------------------- <br /> REVIEWED BY ----------------- - ------------- DATE <br /> - -- ------------------------------------------------ <br /> - -------------------------------------- <br /> BUILD NG PERMIT ISSUED ----------- ------------ DATE------------------------- ---- - <br /> ----------------------------------------------------------- <br /> - ------------------------- <br /> Atera�ions and/or ----------------- - <br /> -------------------• ----------------- ------------------------------- <br /> -------------•------------------- ------------•--------------------------­_---------------- ------- <br /> FINAL INSPECTION BY:---- ---------------------------------------------- Date _:Z-7....`: -�------------------- ............ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street ry 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad!,California Manteca,California Tracy,California <br />