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FOR OFFICE USE: <br /> -------------------------- ---- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------- ------------- ------ - (Complete-in Duplicate) <br /> � r Date Issued ---//- <br /> ._._-----_-.-_--1_Lt. _. --- 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_ _1v_,r-_.Z..__.AV�__}_. K-V )_.__ �-� --------------------------------------- <br /> Owner's <br /> A............ ...`_ <br /> Owner's Name--- vu-------- p_�-�--,•---`----------_-•----------------- -----_-------- ----- Phone_l"U.— .-34-3---- <br /> Address l ..•�.. .... Q/LK- �. .. w, . 1.PQRXX •. .................... <br /> Name------b-A...'lhm. s" ��Q1 --------- ------- ----------------------------------------------- Phone. _ © <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ` ADD of living units: __V-_-_ Number of bedrooms !_._ Number of baths__1--._ Lot size ___._ .PAA ____________________ <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: (If yes,date----------------.-- ) NoX New Construction: Yes ❑ NOX FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material --------------.--------------------------------- <br /> El <br /> ---- .______--_.___._._--._.❑ e%A4TW4_No. of compartments-------------------------Size------------------ - -----------Liquid depth--------- ------- ------- Capacity-------------- ----•-- \ <br /> Dispos I Field: Distance from nearest well-- .Distance from foundatiggn....10.......__.Distance to nearest lot line._-�S__...._.._.. tL <br /> Number of lines �I ----------Length of each line_- _RQ!__-._-._---...Width of trent <br /> 9 <br /> i rA <br /> Type of filter material.-----------------Depth of filter mate ria l_.18__ ------------Total length-----__.P__G'1;..____.___________.. yr <br /> Seeps a Pit: Distance to nearest well-----------------.----Distance from foundation_.257.I.__..r3.Distance to nearest lot liw._--451 <br /> Number of pits--Q/�1 --���-_Lining material ClL..... Size: Diameter._ --._----__-.Depth---- .5_____________________ I" <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) ------ <br /> ------------------------------------------------------------- ---------------}�4h1't1Q1... ,A11�+ / J------- -------------------------- -------------------------- <br /> --­---------------I-----------------------------------------------------------------------­­---------------- <br /> --------------------------------------------I------------------------------------•------------------------------------------------------ --------------------------------------------------------------------------- --- <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 F,l�les and regulations of the San Joaquin Local Health District. <br /> Nb(Signed)-------- '-A j(')A�Q I ------- ..... <br /> Sws---------------------------------------------------- ------ - ----(Owner and/or Contractor) <br /> By:---------- --------------------------------------- --------------------------------------(Title)-- `-M - -- - - <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--- ------ - -------------------------------- ----- -------------- DATE- f/-/° -------------------------- <br /> ------ <br /> REVIEWEDBY--------------------------------------------------------------- ---------- -----------------•----------------------------- DATE------------------------- -------------- <br /> BUILDING PERMIT ISSUED---------- ------ DATE----------------- --------- <br /> Alterationsand/or recommendations------------------ ----------------------- --- -•- -------------------------------------------------•-------•--------•--------------------------•-•--•------- <br /> -----------------------••------- ------ •----------------I------------•---------------_- -----------•----•-------••--••------------------ <br /> •----- <br /> FINAL INSPECTION BY . _-. -. _ Date........ _".-L G <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 />