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r1-)r,U.r1`11L_t: L) t- <br /> ------------------------------ ------------- ---I------ <br /> ------:11.­ APPLICATION FOR SANITATION PERMIT Permit No. IfZ... <br /> 111 ----------- ----------------------- ---------- 1Z <br /> -- - --- ----------- ---------------------------------- (Complete in Duplicate) <br /> ------- ----------------­._------- --------------- --- This Permit Ex fres I Year From Date Issued Date-Issued --- <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install thew 30 <br /> This application is made in comp e work herein 2escrSied. <br /> hapi;e.wij�.pounty inance No. 549. <br /> M7HF:WP <br /> JOB ADDRESS AN <br /> 10 <br /> L Owner's Npl"a ------- ---------- <br /> ----- ------ - -------- -- ----------- ------ ► ----------- ------------ -------------- Phone <br /> e-4----- <br /> Address--------r-L.1,00-V lQ <br /> ---- --- -- ------- ---- <br /> ---------------------------------------------------------------------------_-------- <br /> .Confractor's. Name------- ------------------- - ------ <br /> Installation will serve: Residence - -Z-1, __ ____,S� --- ---------------------------------- Phone. <br /> Apartment House [3 Commercial El Trailer Court El Motel 0 Other ❑ <br /> Number of living units: -1---- Number of bedroomsumber of baths -1't- _Z) <br /> P ot size -r--5 <br /> Wafer Supply: Public system E] Community system [EPrivate E] Depth to Water Table -------- ft. ---------------------------- <br /> Character of soil to a depth of 3 feet: Sand ]' Gravel E] Sandy LoamP-16ay Loam El Clay ❑ Adobe I-] Hardpan E] <br /> Previous Application Made: (if yes,�Iclte--------------------) No [I New Construction:. Yes <br /> 99-15-o El FHA/VA: Yes El No <br /> ITYPE OF INSTALLATION AND SPECIFICATIONS: <br /> _'!'(No_`sep+ic_tank or cesspool i d <br /> permitfe;�­if bl" sewer iil-ail " le wif hi <br /> ,��ubljc sew ay a6 n'200-feet.) <br /> Septic >W Distance frorn nearest w .......Distance from fou4dq�ol _0�r. .. <br /> '.1---/----- -- ----mate r�i__, <br /> E!r No. of compartments--------------------------S i z eS_4_47 16 10 tj' ---------------------- --------- -- <br /> Liquid depth.1S_Z---------------Capacify__<F0V --- <br /> ' Disposa��Id: Distance from nE f wefi,&IJ------Distance from foundat-, / V e - eJ�41 <br /> on,-- ---P)stance to nearest lot line.......... <br /> Number of lines.' <br /> Ik �,I ---- ------- ---._ <br /> ­Le'ngf' Ofreach line-- idfh of trench__3 -------- <br /> Type of filter ma,ie,j ---Depth of filter maternal--_----/-- - ------------Total length------------------- ....... <br /> 17'W ' <br /> ----------- <br /> :Seepage Pit- Distance to nearest well---___---------- ---Distance from foundation--------------------Distance to nearest lot line----- <br /> El Number of pits--J------------------Lining material----------------------.Size: Diameter_------ ----- - -----Depth---------- ---------------------- <br /> ------------ <br /> .Cesspool: bistance from nearest well-----------------Distance from foundaf ion--------------- ... Lining material------------------------------------- <br /> ❑ <br /> Size. Diameter----- -------------------------......Depth------------------------------ -----------------_--Liquid Capacity---------------------- ---.gals. <br /> Privy: Distance from nearest well-------------------_________-------- <br /> ---- -_-Distance from nearest building----------------------------- ------- ---- <br /> ❑ Distan'c'e to nearest lot line <br /> IL----modeling and/or repairing (describe]:--__--._---------1II - -- <br /> ------------------------------------------------------------------------------------------------------------------------------- <br /> - <br /> ----------------- -- ----- ---------------------------------------------------------------I----- - <br /> -----------------------------------------------­---------------- 4- ----------------- <br /> -•------------------ <br /> l <br /> - <br /> j----------- ------ --------------*------------------------------------------------------------------------------------------- -- <br /> ------------ - ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ - - .......... <br /> I hereby certify thaWhave prepalred this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, rules and regulations of the San Joaquin Local Health District. <br /> Signed)--- . 2.y &, niq4t I <br /> _SrPTIC'­rATTK--SERVICE---- --------------------------- --- - --- ----- --- ----------------------------------------------4Qw#AWNn=VaL_Qonfracforj <br /> Y:-29l,5E.-MinerAK4�._� --HO6-3841--,z,;;�- <br /> --------------J----------- ----------------------------------------------------- --- -------- ------- - -----------�(Tifle------------------- --------- <br /> ing <br /> (Plot plan, showing size of lot, location' of system in relation o w S, building <br /> etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........'T� (9- <br /> REVIEWED BY------------------ ------------------------------ -- ---------------------------------------- DATE-------7 A?-2------2v. ...... <br /> OFUILDING PERMIT ISSUED- ---- --------------------- ----------------------------------------------------------- DATE------------------------------------------------------------ <br /> ----------------------------------------- ----------------------------------------------------- DATE <br /> Alterations and/or recommendations:._--_--_------------- <br /> - ------------------I--------------------I--------------------I---------------------I---------------- - <br /> -------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------__--------------------------- ------------ ------------------ ----------------------------------------- ------------------------------- ----------- -------------------------------------- <br /> ll ------------------------------- -------------------- - - ---------- -- <br /> 4. <br /> -------------------------- ------------- ------------------------:--- - ------------------------------- <br /> -- ------------------------------ - --------------- ------ - --------------- <br /> ----------------------------------------------- - ------------- - ------------- ------------------ <br /> hNAL lNSPECTIGZL1 BY_- <br /> ---------- ------------ <br /> Date------- ------- /,R <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 />