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N-)K UrNU: USt: A - <br /> r [ <br /> y <br /> ------------------------ ----- -___---.--_ APPLICATION FOR SANITATION PERMIT Permit No. .__c - /.-_. <br /> r ------ <br /> (Comple#P in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued _-_ ----------- <br /> 1 <br /> I Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made in com liance with Counfy.Ordinance,No. 549._ <br /> 1.0 T- )l , �r8 ,,..E. . ., d,ll-- 2.�i�j- Zia 33 <br /> JOB ADDRESS AND/LOCATION - � R+ PQ-1 <br /> Owner's Name--------- R5-------D0- Phone <br /> TT-1------------- -------------- --------------------- <br /> Addressf = _�- ST-=--------- --------------------------------------------------------------------------------- <br /> /�1TC <br /> Contractor's Name1F � CAr1- <br /> --- ----------------- ---------------I--------------------------- Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel [] Other ❑ ' <br /> Number of living units: _ --- Number of bedrooms __ - Number of baths ;2;­�-Lot size ----1Z 400 17 ` ? <br /> Ir---- ------------------------------------------ <br /> ti <br /> Water Supply: Public system ❑ Community system ©�rivate El Depth to Water Table - fi. sQ <br /> { <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 '0--___New Construction: Yes �o ❑ FHA/VA: Yes PE�—_No it <br /> TYPE-OF-IN <br /> STALLATIC)N,AND-SPE.CI.E1QATIOLRS-. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta k: Distance from nearest well ,� J t <br /> �'1 -�-c_�`�-_Disfance from foundation-_.�- E I` <br /> [�' d-----------Mat nal_CL����.-----r------- ----- -- <br /> No. of compart I nts____-- --------------Size-� 40_� _IZ®O Liquid depth__ ` 7— Capacity___�5_OC <br /> ,,,,,,II <br /> Disposal Field: Distance from nearest well__,cx_]f—Distance from foundation----ZiQ--------.Distance to nearest lot line—.5— <br /> Number f <br /> ®� Number of lines-- --_-_---- - -----Length of each line-�Dpd S�__-_Width of trench---Z.�-�' <br /> c[ --- <br /> Type of,filter ma -_r,___Depfh of filter material---_._19_-____...-_Total length_------__---1.5`' <br /> w ------ <br /> Seepage Pit: Distance to nearest weli._,_C�_W----Distance from foundation----0----------Distan/c to nearest lot line__:____-_ <br /> Number of pits--:I..�.............Lining material_PiQCk';i,---.Size: Diameter.-Y_X-_75-------Depth_..__1'7 _ <br /> Cesspool: Distance from nearest well-.-.-------------------Distance from foundation- -------------Lining material <br /> ❑ material_____Size: Diameter.. -------- Depth-------------------- -------- -------Liquid Capacity...__________________ <br /> - ------------------- <br /> -- <br /> ' <br /> gals. <br /> Privy: Distance from nearest well------------------- -----------------------------Distance from nearest building <br /> El Disfance to nearest lot line-_----------------------------------- <br /> --_ r <br /> Remodeling and/or repairing (descriLie)_-----------------_------------------ <br /> -------------------------------------------------- <br /> ------------------ <br /> - ---------------------------------------- <br /> ----------------- <br /> f <br /> ----------•---------•----•----------=-------- --------------- -- -- <br /> 1 - <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------- } <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 Iregulations,of the San Joaquin Local Health District, <br /> ..(Signed);;.,,,- <br /> Si _ ------- ------- - ----- ----------------------- <br /> -. . � -� _(Owner and/or Contractor <br /> By:--------------- (Title) __Mew <br /> (Plot plan, showing size of lot, location of system i la on to wells, buildings, etc., can be placed on reverse side). <br /> i ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- L.R--- ----------------------- ------------------- ------- <br /> REVIEWED <br /> DATE <br /> E I -- -- -- ---- s---- --------- ------------ -- DATE-------=--------------------------------------------------- # <br /> BUILDING PERMIT ISSUED - ------------ - ----.- DATE.- ------------------------- - <br /> -- --------------------------------------------------------- <br /> -- ---------------------------- <br /> Alterations and/or recommendations:-_(_.__..---_____----------------------------- i <br /> -------------------------- <br /> 1 <br /> -------------------------------------- - -------------------- ---- <br /> ---------------------' <br /> --------------- <br /> -----------.---__----_------ <br /> __ ------------------------------------------`---------•----`-- f <br /> t -------------- ....... . ................... <br /> t <br /> FINAL INSPECTI l�J- Date------- ------ <br /> �.. -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> 1601 E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street : <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />