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FOR OFFICE USE: <br /> ------------------------------------------------------ <br /> -_-___-_______-__ APPLICATION FOR SANITATION PERMIT Permit No. �� .. <br /> - � <br /> -in Duplicate) <br /> )-------------- ---- ---------- -- - - -- (Complete d <br /> Date Issued .�/�•-�d <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 compliancewith County <br /> Ordinance No. 549..E <br /> JOB ADDRESS AND LOCATION_+_Xdd_I.._ y_ --/- _- ' _/_ -_ _ __� ..._.r..__.__.p. <br /> Owner's Name---- � 0. ...... <br /> ...(.._h-$ �./v-•-----------------•----- ----------------------------------------------------- Phoned's��.'"_��J_�.l <br /> Address- W7/?:.g <br /> .�. <br /> Contractor's Name------. 1�1J '! _� 'rte __--!_Tt` .t _�-./�f t rZ" �-------.-- Phonei'- ? <br /> .....�e................ <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/___ Number of bedrooms_-_ Number of baths,2___ Lot size __' __- --. <br /> Water Supply: Public system ❑ Community system ❑ Private (Depth to Water Table g_ _ ft <br /> Character of soil to a depth of 3 feet- Sand (Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No [T" New Construction: Yes ❑ No To/FHA/VA: Yes ❑ No g4,*� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well-.�t0'.__._._Dist C from fou�ation_ A0__ .._--_.M t r�� C CF -_____________ <br /> p _- • _{✓Liquid depth__' ..-- ____-__ Capacityf..�L�d No. of compartments Size____ ..__._ <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-____.__-___----- <br /> ❑ Number of lines-------------------------------.-_Length of each line-_ -----------------.---------Width of trench------._-___-_________-__-___...._ <br /> Type of filter material___...__.___.._.-------Depth of filter material----------------------- length----.____________________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____.____-.__--- 0 <br /> ❑ Number of pits----------._.---.__.Lining material--------------. ------ Size: Diameter_______________________Depth_-._.------------------......... ^N <br /> 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 /> ❑ Distance to nearest lot line---------------- ------------------------------------------••--••-----------------•------------------ - <br /> Remodeling and/or repairing (describe):_--1�,Z_11,09clwlf-____ox—P--____����1®- .C��___l l� ..-W..dl ���_.... <br /> ------------�'�l��---•---'a..r w •--------- -------------------••--------------------- ---------------------------------------•-•--••--•------- ----------- <br /> ---------- ------------- ----------------------------------------------------------------•-------------•------------------------------------------ -----------------------------------------•-------- ---------------------- <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) _? r�� i �,' / s'/1� � '..i --- ( "er�bnd/or Contractor) <br /> BY: 4-4r_ - ----------- --------- ------------ -- (Title) 0``' <br /> (Plot plan, showing size of lot, location of sys min relation tow s, buildings, etc., can be placed on reverse side). <br /> FOR DE RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- �t.R---a----------- ------------------------------------------------------- DATE------------/f___!!_Q=16 - <br /> REVIEWEDBY-------------------------- ---------------------_------------ -------------------------------- ------ DATE----------------------------- <br /> ------------------------------ <br /> BUILDING PERMIT ISSUED---------- ------ DATE------------------------------------------------------------ <br /> Alterations and/or recommendations--------------- -- -------------- ---------------- ----------- ------------------- --•---------- ------------------------------------------------------•------ <br /> ------------------- ----- ---- ----- ----------------- ---- -- - -------------------- ------------------ ------ ------- //------------- --------- ---- ------ <br /> FINAL INSPE - ---------- - -- Date.------ - <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 /> E.H.9 2M 1.67 Vanguard Press <br />