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FOR OFFIC US <br /> 3 - <br /> ,/ APPLICATION FOR SANITATION PERMIT Permit No. ../....--- <br /> i . �Q _ Date issued . S f -. <br /> -!-_-:- - ---7 ---�--- (Complete in Duplicate) I e /x3` ,;` <br /> f',; ':' <br /> }` rt'__--------- This Permit Expires l Year From Date Issued <br /> wC 4 5 <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described <br /> This application is made in compliance with County Ordinance No. 549. r 1 <br /> JOBADDRESS AND LOCATION--------_--------- --------------------------------I-------------- ----------------------••---------=------•-- -------------••------------------------------•- <br /> Owner's.Name "" 4..T.-!`. 1 -•-------•------------------------------------------------ Phone __ <br /> Address------ _-----• I Clime_=------------�( ©` ------••--- --- --- ------•- --------...-------------------•----------------------------••-•-------- <br /> EE k <br /> I <br /> Contractor's Name. =.�iuf-#--l�j -�,(�,�1-•-----�_+��';- ---- �'C.�--------••--------------------------•---------- Phone---��--Z..;?cf 5-4 <br /> Installation will serve: Residence [Apartment House E3 .Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ) <br /> Number of living units: __tyNumber of bedroom , ` <br /> �_ s- -:- Number of baths ..-_-mot size ...... -. <br /> f Water Su I Public system Community system ❑ Private ❑ Depth to Water Table (ex-'�_ ft. <br /> t PP Y Y <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 QNew Construction: Yes No FHA/VA: Yes F1No E] f� <br /> f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: l <br /> r (No septic tank or cesspool permitted if public sewer is available within 200.feet.) <br /> tic T nk: <br /> Distance from nearest well-----------------Distance from foundation.;[[.-_--_-_---.___:_.Material_._._..__---....._-___.____----__...._;.__:__-. ..� <br /> No. of compartments ------------ f <br /> 5ize. .--•--------------- - ---_Li uid:de th---------:----------------Ca Capacity ' ") <br /> �. q � p P tY r <br /> i <br /> posal Fie Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line------- <br /> - <br /> Number of lines------------------------------------Length of each line----------- ----------_------Width of trench.------.------.------.----f-------- <br /> Type of filter material---------------- ------Depth of filter material____.--------_.____Total length--------------.._____:-:-.. ------`-----,k <br /> Seepa a Pit: Distance to nearest well__AD_'T',1_Disf6nce from foundation_-., _. Z. _Dista cee-Io nearest lot line____________ _33 <br /> Number of pits-----]---------------Lining material__,kQ_sCE.1A__r.....Size: Diameter. .,- --.Depth.... ............. ;!: <br /> Cesspool: Distance from nearest well_________________Distance from foundation^= `"° TLinmg•material:_=.__-___-,-...__---:_.__.-__.r <br /> ❑ Size: Diameter------------ -------------------------Depth-Depth_,-------------------- ` L'iquirl Capacity �=; --------- .gals:4 <br /> --------Disfance from nearest building -A------__ .=_--..._. r <br /> Privy: � Distance from .nearest well----------------------------------------- � 9 -------`;=;-• <br /> ❑ ; <br /> Distance to nearest lot line---- = •--•---- ----------------------------------------------------- <br /> Remodeling and/or repairing (describe)---------- ------- ---------- ---- -- --------------- -------- = ------•-- ------------ --------------------•------ <br /> 1 <br /> _= _ ---------- • ------------ `--�------------- <br /> - - -- ------ ---------------------------------- ------------•------------------•-------------- ..-.---------- <br /> ------------------------------------------- <br /> -------- ! I <br /> ------- ----------------------------f`------------------------------------------------------------------------------••----------------------------------------------------------------------- <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.regula+ions of the.San Joaquin Local Health District. <br /> Contractor <br /> (Signed)-- { e - .:~` "' ; ) <br /> r <br /> g # -------------------------------------- -- --------- -------- <br /> (Plot <br /> ---------------------------- - (Title)-- -- <br /> (Plot plan, showing size of lot, location of sys+em in relation to w , buildings, e -.,Ucan be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY s <br /> ... <br /> APPLICATION ACCEPTED BY-.---j------- l ..J---------------------------- -DATE ' = <br /> k ... <br /> REVIEWED,BY DATE <br /> BUILDING PERMIT ISSUED---------•---•-----------------------------­--------------------- ---------- -- t DATE <br /> Alterations and/or recomm ridations: = • . I ------••-------- --------------------------- <br /> 4 — <br /> --------------- ---.; . <br /> --4 ---( ..�. ',.ate -`- .... - :� <br /> -lie ------------------ <br /> y <br /> .� l <br /> ----------- --- - ----- <br /> -A---- ------------- �----------------------------------- -- . <br /> FINAL" INSPECTION BY:.._-_: l�{_/t L Z------• Date`__-_..- - ---- ----._ - <br /> . ------------------------ <br /> r SAN JOAQUIN LOCAL HEALTH DJilCT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> I Stockton,California Lodi,California Manteca,California Tracy,California <br /> E0.9 REVI9EC&-SO F.P.Co.2M 11-60 <br />