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FOR OFFICE USE: 1 <br /> ---- ------_--- --- - -------_----- ------------ ,APPLICATION FOR SANITATION PERMIT Permit No. <br /> -- -C�•c � ��- t <br /> ------------------ ------------- ------------------ (Complete-in Duplicate) <br /> -- - bate Issued <br /> --- - <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,applicat.ion•isrmade in compliance with County Ordinance No."549. 2 <br /> iJOB(ADDRESS AND OC T ONolaoS'/ A` .� ,F.aFr�r�t�:.ron_� - ie `- --------2- ------------ <br /> Owner's Name_=S'ocYi �+/ t. � Qu!/�- JP/PlG`iOToi✓ LS �l4 Phone , ' /O/ <br /> Q_ .. +� -sT" '!��►' ' ''�� ..--------------------Add ------------------------...------------------------------------- <br /> � -----.- �-� . <br /> Contractor's Name---<._^t` r'-e-----7el-—r-------- -- -- -----------------------­--------------- Phone2923~_41._D.� <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑�M•.otel ❑ Other [g� <br /> Number of living units: __ ____ Number of bedrooms -------- Number of baths-------- Lot size ---------------- <br /> Water Supply: Publics stem Community system ❑ Private eDe th to Water Tablekll_ ft <br /> pP Y� Y ❑ Y Y L�7 P <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,�New Construction: Yes gy'�No ❑ FHA/VA: Yes ❑ No <br /> TYRE OF :INST.ALLATION�AND SP_ECIFICATIONS•� -,, <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .;�.�.Material�.;.D�1C',�FTF-------------- <br /> Septic' T nk: Distance from nearest well-�� __Distance from foun tion_ * <br /> j `�- ° <br /> No. of compartments---�................Size_' :XhX __Liquid depth__fjF<_rh._._. ------- Capacity�eZQiiP_.___ <br /> Disposal !eld: Distance from nearest weil_S�.�_-Distance from foundation_.�� "-' <br /> � Dis a# nce to nearest lot hie_________________ <br /> Number of lines ----_^---------------------------Length of each line__ . ---•�_--_...Width of trench.,�.4_' ------------------ , <br /> Type of filter materialX&C&..-- --Depth,of filter material...f�_°,:.---"-Total -length---1-57-40------------------------- <br /> I .. Seepage Pit: Distance to nearest well--------------------__Distance from foundation-------- ______.Distance to nearest lot line----_____________ <br /> ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter-----------------------Depth...-------_-----:--------------- j <br />'r Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material____._____.___.__---_-_.._________._. <br /> ❑ Size: Diameter ---- ----- - ------Depth---------- --- ----------------------------- ------Liquid Capacity....-----------------------gals J. <br /> Privy: Distance from nearest well------_----------------- _______________________Distance from nearest building_-_--..______.______--___.__.__..__..- <br /> t <br /> ❑ Distance to nearest lot line-------- ----------------------- ---- -------------------------•------------------------ ------------------ ------------------ <br /> Remodeling <br /> - --------------Remodelin and or re airin (describe):- ----. Q7 - - ---- 'F-"`--------------------------------------------------- <br /> qr' <br /> -----------------------_-------------------- ----------------------------------------------- ----------------------------- ---------------------- ----- --------------------------------------- <br /> -------- -----•--------•------------------------------- <br /> -----------------•--------------- ----------------------------------------------------------------------------- <br /> i <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) C.�O�_ �✓ � � - ----------- •---- ------_. --- -. and/or Contractor] <br /> -------------_- ----- --- . .- ----------- ------ = itle) _ �- <br /> (Plot plan, showing size of lot, lova of system in relation to wells,'buildings, etc., can be placed on reverse side). <br /> p FOR D PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- �-h .O-------------- - DATE--------`�, '� <br /> REVIEWEDBY- ---------------------------------- ------------------ ------------------------------------------ --------------------------- DATE------- -----------•-------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- ----------------------------------------------------------------------- - ----------- DATE------------------ --------- - ----- ------------------------ <br /> Alterationsand/or recommendations:.--------- ------ -------------- - -- ---- ------- ----------------------- --------- --------------------- ---------------------•----------------- --------- <br /> h ------------ -----------•-------- ------------ ----------------------------_---------------- ------- --------------- ------------------------•-----I-------------------------------------------------•--------- <br /> ------- -- ----- --- <br /> -- - / <br /> i ----------------- --------- ----------- - - -- --- - ----------------- - <br /> �- � <br /> FINAL INSP Date - - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxetton 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 />