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FOR OFFICE USE: 1I <br /> ------------------- ------_ -------- --- ---- <br /> f APPLICATION FOR SANITATION PERMIT Perit No. c2,-_� � <br /> .---------------=--------- [Complete in Duplicate) <br /> -------- <br /> --- ---------------------l Date Issued /Datme,. [ssued ..._...'-1-'--.-.� <br /> - is Permit Expires 1 Year From <br /> _ -o z(- IL1 l <br /> Application is hereby madtj�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 Oth County Ordinance No. 549. �' ►�L-�1-'p <br /> JOB ADDRESS D LO ION rY <br /> ION � !., h� �-----.. .�_ '�f. /.�l" 0 --/���-4-'� � r <br /> Owner's Name--- � Yip � Q ---•- � � / --- -------,----------------------- ------ Phone_&1d7__ <br /> Address--------------� b?, j'------N.,•------------- u XQ <br /> ------- <br /> VA/ <br /> Contractor's <br /> t---- <br /> Coritractar's Name 1L`I�Ihh =.�Y�c� ' j� �/L .- �! �.-..-.. Phone... " �i-T�. <br /> Installation will serve: Resil.:ence>e Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> II. <br /> Number of living units. Number of bedrooms Number of baths -4--. Lot size .. 1�III --P-_ ...._.. .. -. <br /> Water Supply: Public system ❑ Community system C Private Depth to Water Table ft. N <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2��ardpan ❑ r <br /> Previous Applicafion Madeli{If yes,date--------------------) No E] New Construction: Yes- No E] FHA/VA: Yes [-] No ❑ <br /> 'I' I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pub' ewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well __-_o- Distances, fro fo}n a ion----/ .........Macar ��.'.� .._-___. .. <br /> No, of compartments._ _______________Size_. xX.(? _._Liquid depth..... ..........Capacity....� l.iJ.. <br /> 1111' <br /> Number of line Length o{rom foundation...l� istance to nearest lot 1jrye..... --- <br /> Dispos 1 Field: Distances from nearest well ---------Distance fFeach�lino-�Q�-��.�•�..W.idth of trench.�.��.........��...�..._....-. <br /> - <br /> Type of'I filter material ---.Depth of tfilter material---- -.....Total "length.-.-- <br /> Seepa e Pit: pistance to near well___ -��.-__..__Distance from.founclation___. .�_ _....Dis't n e to nearest,', lot line..-.�...-. <br /> Numbest of pits_- ---------------Lining material...-- ' . '"" `Size-Diameter--j-d...: --.-.--Depth_ ------------------- <br /> Cesspool: Distancell from nearest well-----------------Distance from oundation._._..-----.........Lining material.. ____.___.___._._-_-- <br /> ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well ............._1.-.._....._..-------.--------..Distance from nearesf building---------- <br /> ❑ Distance fo nearest lotline----------------s-------------------------------------------------------------------= ------------------------t------------------------- <br /> ' <br /> pt <br /> Remodeling and/or repairing (describe) ' --....- <br /> k. <br /> ----- <br /> ------­-------------------------!I1----------•---------- 1 ---- - --------------- 1 <br /> ---------------------------------------------- ------------------- I li ' ----- <br /> I <br /> II I -`• f )-- I 1 ' 1 <br /> -------------------------------------------- --------------------------------------- - -----••-------------------- ----•----=-------------- ------- ------ <br /> I hereby certify that I .� ve prepared this application and-that the work will be d ne in accordance with San Joaquin County <br /> ordinances, State laws, andlllr Rs and regulations of the3San Joaquin Local Health Disir"ict, t f <br /> a VIY41 y x 3 [ ¢R <br /> (Signed) ~ ------ ----- - --------------- 4 --------------{� Contractor) <br /> SEP Cf 1"A -- <br /> INK -+ .„ <br /> B 2915 E.Miner �e„- - Ho.r.-384,t- Tltle I} ` <br /> Y - _ - -- ,�^`- { '�) ---,,-:----- - - - ------ -- ----- <br /> (Plot plan, showing size of lot, location of system in relation to w Is, buildings, etc., can-be-4plac d,on..reverse..side). <br /> ill FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTE6 =3 DATE ..' <br /> 7 . ------------------- <br /> REVIEWED BY- -- ----------- - ,.r. ------------­----------------- DATE------------ = '•-:__---.:=-'---------� <br /> - --------- <br /> BUILDING PERMIT ISSUED11------------------------------------------------ --------------------------------------------------- DATE--------- ----------------------- ---------------- -------- <br /> Alterations and/or recommelr►dations:------------------ ------ ..___. _ ! <br /> II i N I <br /> ----------------------------------------------=------------------------------- ------ ---------- -- -------------------------------------------------------------------------------------------------------------------------- <br /> ,II. a 1 <br /> ----------------- ------------------------------------------------- <br /> ----------------------------------------------=IM------------------------------------ -----------------------------------°".�.,,,:,_u <br /> ------------------------------ <br /> .II _ - <br /> FINAL INSPECTION BY. Date----- ------�s�_. -•-.-- <br /> � � t <br /> -- 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street s <br /> Stocktorn,California Lodi,California Manteca,California Tracy,California <br /> i <br />