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FOR-OFFICE USE: ZI <br /> x <br /> - fl- <br /> _.__iy___________________________________________ --- APPLICATION FOR SANITATION PERMIT Permit No. ....................... <br /> -------------------------------------------- (M---- (Complete in Duplicate) <br /> ---------- ._ This Permit Expires 1 Year From Date Issued Date Issued --- <br /> - kj, <br /> Application is hereby made.1lto 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 OCATION-----__� �-p� <br /> •-- ------------------------------------ --------------------------------- ------------ ,] d ---------------- <br /> Owner's Na ------------- -------III- -•----------- --- ._ on <br /> �7 a -------------------------�.­ <br /> -.-.-_-4s�__---- '– <br /> - -- ------- <br /> - ------•- --------------s------------• --•-------...`_-..,------------------ --- <br /> Contractor's Name l` -- ---------- -------- ----------------------------- ------- PhoneA/4 ----------`— ---- <br /> Installation will serve: Residlence ❑ Apartment House;K Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living uniti�: _- _____ Number of bedrooms _jF_- Number of baths _ -_ Lot size __ p <br /> Water Su I Public s stem ( Community system Private Depth to Water Table aZ ft. <br /> 4 - Supply: Y Y Y ❑ ❑ p �. <br /> r~ Character of soil to a depth,of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: 11 yes,date--------------------1 No X New Construction: YesK No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION IND SPECIFICATIONS: <br /> septic.,.fank7ot te�'Spool_permiffedmifpublic_sew-er.js available within_200..fe0...] <br /> Septic Tank: Distance from nearest well_ Distance from foundation-j-P.__...._..Ma ial-- _------------------------------------------- <br /> k No. of compartments--__*�----- ---------SizeZJ_� (�X_ -'Liquid depth-----�----- __-.....-Capacity-�Q.ZS� -� <br /> !I` a r Pi; <br /> Disposal Field: DistanceI rom nearest we11 Distance from foundation__,R 5.......Distance to nearest lot line_-�O.. <br /> Number-,of lines_ 1,3'1,3-._$?.Width of trench.-------43_-l.�__________ ___ <br /> �. �--------- -------- ------ Length of each line- -- -__-- _ . <br /> E Type of filter material.$,,J�Depth of filter material----/.9-______-_-.Total length----10 ---------- <br /> Seepage <br /> ------__Seepage Pit: Distancel`to nearest well-_____----------------Distance from foundation___-----_._---_---.Distance to nearest lot line-----.......T1�0 <br /> ❑ Number of pits.---------------- .Lining material.----- ----------------Size: Diameter-----------------------Depth..........._-__----------------_- <br /> Cesspool: DistanceTfrom nearest well-----------------Distance from foundation--------------------- material_-.-_.-..-----_-..._----.______----_ <br /> I <br /> k ❑ Size: Dia-peter- - - --------------------------------Depth-- ------------------------------------------------- Liquid Capacity-- -------------------------gals. r <br /> Privy: Distancelfrom nearest well----_________-- _______ _____________Distance from nearest <br /> ❑ _ <br /> buifding_-______--._______.____-_______.._____- <br /> Distance4a nearest lot line --------------------------------------------_------------; . -- ----- ---- <br /> Remodelin o <br /> and/or repairing) (describej:----1Y�1n/.____.,[-Q'T--- 't ,)l-------V A_R-tA-NC�------49•_A_....1i3��A_�.7 _ <br /> tihT --------o-F--------n-_ry -5-F_ v R.S_------uur` tlf_nC {3 = ------- <br /> m <br /> �-r -------.DF-15-1 f-G-61--------Fa-R-----------3----,?`/`1------A4 .X- <br /> :III1., -- --------------------------------- <br /> I hereby certify that 1424 prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances&Se law ,rand rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ---- ------------------------------------ --- -------- ----- -- <br /> 9 ) , � ��� (Owner and/or Contractor) <br /> gY-----------=-------- - f� -� --- _------- ----- -._.� -� ------{Title)-- _ -._ <br /> (Plot plan, showing size of lot; location of syste in relation to wells, butldtngs, etc., can be placedW' <br /> reverse side). <br /> ql� <br /> Illi FOR DEPARTMENT USE ONLY <br /> ,p p <br /> APPLICATION ACCEPTED BY--�i_l..-Q- - ----- --------------------------------------------------------------- DATE �'~_> `. <br /> REVIEWED BY------ ------------- I_ Al-L <br /> DATE--/. =1 <br /> BUILDING PERMIT ISSUED--(I-------------------------------------- DATE --------------------------- <br /> Alterations and/or recommendations----------- ------- ---------------------------------------------------------------------------------------------- <br /> -----•---------------- - -•------- -- --------=III---------------------- ---------------------------------------------------------------------------------------------- -------------- ---------------------------------- <br /> ..... <br /> . ....... -- -- <br /> ---- ------ - <br /> --- <br /> -- ---------------------- <br /> ------- --------------------------------------------------------------------------- <br /> ------------------------------ <br /> ------------------------------ ----- ------------- -------------- <br /> FINAL INSP - - - ----- 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,CaliforniaLodi,California Manteca,California Tracy,California <br /> F..P.co. r } <br />