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i � � <br /> a 0 Q /1l D lrJ e`1 APPLICATION FOR SANITATION PERMIT Permit No. ...13 <br /> ..................... <br /> (Complete in Duplicate) <br /> - Date Issued ..... .f .... <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 Count rdinance No. 549. <br /> J08 ADDRESS AND AT ...._... ...... ' <br /> Owners Name.....5__•- ....... ; <br /> -- Phone <br /> ....���---_..... _ <br /> Address--- ...................... <br /> Contractot's'Name. - <br /> c�E-k•• � tom- - -- r... --- -^ --=• Phone- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [) Motel ❑ Other /;�,. <br /> Number of living units: -------- Number of bedrooms ........ Number of baths _ Lot site _.....ZZ4. bra. ---.... <br /> Water Supply:{.Public system ❑ Community system ❑ Private�Depth to Water Table //U ft. <br /> Character of soil to a de of Y feet: Sand Gravel Sans Loam Clay Loam <br /> 9 ❑ ❑ y y ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes!D No New Construction: Yes o ❑ _ FHA/VA: Yes Ej No ❑ <br /> r <br /> TYPE OF INSTALLATION AND SPECT ATIONS: <br /> (No septic.tank or.cesspool permitted if public sewer is available within 200 feet.) <br /> + 1 � <br /> Sept'c Tank: Distance from nearest well <br /> .._.._..Distance foundation..f--Q_.--------Material_. j21 ,r. :••_-.- ._---___. <br /> No. of compartments 3 ' a <br /> ��\ P Size -1" Liquid depth............ ..."Capacity_- 294941 <br /> Dis os I Field: Distance from nearest well..6,2i.. from foundation---/.p.........Distance to nearest lot lin <br /> Number of lines....../................. ........Length of each line_....flO-_--`!---_--_.Width of trench.... .5��__..__-.------_. .. <br /> Type of filter materiaf._ROC/ ......Depth of filter material._f .............Total length.......,..©_: • <br /> Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits.....____............Lining material-.... _.........____ Size: Diameter.. Depth................................. <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material..................................... <br /> Size: Diameter......................................De th..................... <br /> .-. .............................Liquid Capacity gals. <br /> 1 <br /> Privy: Distance from nearest well.................................................Disfance from nearest building-----..................................... <br /> i ❑ Distance to nearest lot line.... ..............• ... ----...--•---........--..r_.--------- -----------.................................................................. <br /> Remodeling and/or repairing (describe) =�= E `.....................................•......................................... <br /> � ' ► <br /> _.............•-••----.....------....._..----•-••-•-----.......................•.---••--•-•--•---..........--•-•-.....------ .. <br /> � ...------.....--•--••--.................................... . <br /> �k ` <br /> ......._...----•.............•------.....----••--•--•---••---••----•-•-•---............-•-----•-•--..........................I...................................... — <br /> I hereby certify that 1 have prepar application and that the work will be'done in accordance with San Joaquin County <br /> ordinances, State laws, d rules an egulat' nz of tho San Joaquin Local Health District. <br /> ..._.... -.. �� ' moi Owner and/or Contractor <br /> (Signed)----------- -- I <br /> By--------................-•---......---•----.....•••-•.................. {Title).: = � �r <br /> (Plot plan, showing size of lot, location of system in relati n to wells, build�g, , can tie placed on-�everse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........- - DATE ...~ <br /> ................... <br /> REVIEWEDBY v..__... -------------------------- DATE............................................................ <br /> BUILDINGPERMIT ISSUED................................----------------------- '::................... DATE............................................................. <br /> Alterationsand/or recommendations:............................•-•-----........._..._..----••-----.--.---•-•----•----._-.---------...-•.------..------..---.-----.----•----•-----•-•-----•------- <br /> ...................... ...................•--..--_.....----•••---•..........._•-•-•---..........----...•--......•--•--••--•••----•••••..--•--•........•••...--•-•-••-•••---••-•-•••-•••-•••-•••-......•-•...--•-••._.._.... <br /> ..................................................---•--...............---............_.................._.._......::= ..__... ............................................................................... <br /> .............•............................................................... .._................_.....-••-••.....-----•••_..... •-•-•••-•--•.......----•••------•-----•-.......••----•....•--............••••....... <br /> ..........................•----....._....................._......-------- ----•- . --........................._....._._..........---- .................•-----._.......-----.......--•-•--••--•......--•-•....._......•--••- <br /> FINAL INSPECTION BY: �/ ........................ Date-_6_- / J •.................................................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North •'C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />