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Permit No. --- - •-_- <br /> :APPLICATION FOR SANITATION PERMIT <br /> ------'---- ----- ---- (Complete in Duplicate) <br /> Date issued -----;/ _.�_� <br /> r- ------------------------------- <br /> ---- ------------- ----------- <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 application is made in compliance with County Ordinance No. 549. 1� y,,, , r�io e2 <br /> I <br /> ---- <br /> _- c bnJ - iVT �-=--- - -- -- <br /> x <br /> JOB ADDRESS AND LOCATION = �ic�H ' <br /> i --------- Phone -�-'�---7 K3 --- <br /> = Owner's Name--------J-I-Y'-,----------E_�-�-�3�i�«1_�.-------•------------• --------------------------------- --------------- - � <br /> I - -------------- - - ----------------------- -------- <br /> Address----------------- v r T <br /> °� ' ` ` ' Phone_1�'4. .°a '0a - <br /> Contractors Name---------= 12 l�= t 1 ---------- ------ ----------------- <br /> F� Installation will serve: Residence [a Apartment House ❑ Commercial E] Trailer Court El Motel [I Other ❑ <br /> Number of living units: --I----- Number of bedrooms ..-�_ Number of baths __= - Lot size -------:72 - =r' � --------------------- <br /> FWater Supply: Public system ElCommunity system ❑ Private Depth to Water Table -1d-- ft. <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'` ' No ❑ FICA/VA: Yes ❑ Nox <br /> F, TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [No septic tank or cesspool permitted if public sewer is available within 200 feet.] <br /> Septic Tank: Distance from nearest well----- from foundation------j42--- Materigi----.- ©k1 1 �---------------- <br /> No. of compartments----_--lf�--------- Size--- _!C- --- ------Liquid depth--------_/le!n-------Capacity--L"_a---,fir <br /> ` �-!_--_.Distance to nearest lot line----- <br /> -`_- <br /> Disposal Field: Distance from nearest well_--_��_�_--.Distance from foundation..__-- <br /> -Z <br /> } Number of lines-----------3---------------------Length of each line----------(3-0..............Width of F. trench.------------��-"_------.--- <br /> �` Type of filter material-__'fC�_1e--------Depth of filter material_-_____�-�_'_�--_.-Total length--------------------��O__'__-.____ <br /> Seepage Pit: Distance to nearest well____-------_---------Distance from foundation___________------_.Distance to nearest lot line----------------- 9 <br /> ❑ Number of pits-- -------------------Lining material--------------_--------Size: Diameter-----------------------Depth--------------- <br /> -----------____-- <br /> t Cesspool: Distance from nearest well-----------------Distance from foundation------------_---_-.Lining mater•sal__-.._----------_----_-----:--_-._-.-. <br /> I <br /> ❑ Size: Diameter---------------------------- ------Depth --------------------------------------------------Liquiri Capacity---------- •---------------gals. <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building_-------_-._---_.-------_----_---..---_--- <br /> ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- <br /> Fi <br /> -- <br /> -•--------------------------------------------------------------- <br /> Remodeling and/or repairing -(describe)-------------tL":.Jt <br /> ----------------------------- ------------------------------------------------------------------ <br /> -------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------- <br /> -------------------------------------------------------- <br /> ------------------------------ -----------------------------------------------------------------I-----=--- ------------------------- <br /> I <br /> ---------------------- <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 and regulations of the San Joaquin Local Health District. <br /> (Signed) ----- - r�-. — '----------------------------------------------------Owner and/or Contractor) <br /> & 1- `�- .,.�2 ----------------- - [Tit�e� s` -1. <br /> y' — <br /> Plot Ian, showin size of lot, loca ton of s stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> P g ,. .._ y <br /> FOR DEPARTMENT USE ONLY <br /> ' DATE Y <br /> APPLICATION ACCEPTED BY--------------------------------------- <br /> REVIEWEDBY------ r ------------------- RATE-- =_---- ---Y..---------------------------- <br /> F++ BUILDING PERMIT ISSUED --------- -------------------------- DATE- <br /> Alterations <br /> ATE Alterations and/or recornmend ations:------------------------------ ----------------------------------------------•--------------------------------•------------------------------ <br /> ---- - --------- <br />{ ------------------------------------------------ -- � <br /> ----------------------------------------- - ---------------- ----------------------- ---------- ------------- . <br /> ----- - - ---------------------------- <br /> ---- ------ ----------------------- --•------ <br /> --------------------- - -------•-(}- - -fit;------- <br /> FiiFINAL INSPECTION BY---------------------•- " ---------------^ Date.- ---------- r%.- ,• <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> FF! 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca, California Tracy,California <br /> I <br />