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FOR:OFFICE USE: <br /> ------------------------------- <br /> --v APPLICATION FOR SANITATION PERMIT Permit No. ._._..`................ <br /> u-t c:k- --(1--t- -- -- <br /> --- -------------------- (Complete in Duplicate) <br /> ------------------------------------- <br /> - Date Issue --.•---------------•--- <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. <br /> JOBADDRESS ANDOCATIO _--- fl f..._. a /.Y_Z/ --------------------------------------------•---•-••---------------•------------------•--•--------- <br /> Owner's Name---- _ -----•- -- --- - ----" ------------------••----------------- <br /> ---------- Phone------------------------------------ <br /> Address__. -­ . <br /> Contractor's Name-------- �� ���� ---------------------------------------------------- --------------- Phone----------------------------------- <br /> -- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --/--- Number of bedrooms _ Number of baths /__- Lot size _ � -*�' •--••-------•••-------- <br /> Water Supply: Public system ❑ Community system rivets ❑ Depth to Water Table , ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (If yes,date_----------_--------) No ZR—New Construction: Yes ?a--No ❑ FHA/VA: Yes�1do ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> t (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) <br /> Septic >nk: Distance from nearest well-----------------Distance`'from'foundation__:_`p___.___.Matt�al--__-' _-�__ - ----------- <br /> No. of compartments__-_-/ _____________'Sizes, f;x..gt_____,___Liquid depth___-k____-_________Capacity.A.Ina-_-�___ <br /> Disposal Field: Distance from nearest well-----_""""'____.Distance from foundation---le----------Distance to nearest lot line_��_�_______ <br /> �� Number of lines] .,_/ ____ Length of each line___ -_- _-_��____.Width of trench_,�____________________________ <br /> Type of,'filter melena -1 _Depth of filter material____ ------ otal length______, -f_________________ \ <br /> Seepage Pit: Distance to nearest well-------10~x.___Distance f om foundation___f ____.___.Distance to nearest lot line_'______________ <br /> Number of pits______A_-________Lining material_/ ��+__.Size: Diameter___ r ��-_-_-Qepth___i _��._.________.._. p\ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______._____-_-_______-.._._._______- N <br /> ❑ Size: Diameter------------------------------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals, �p <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building-------------------.--_______.___..----_-- <br /> ❑ Distance to nearest lot line----------------- <br /> "------------------------------------------------------ /- <br /> - <br /> Remodelin and/or repairing (describe):----------------------.r�GZ�/-- - --- . ••---------- 4A6T. �_____________________________________----______.__.__._-- <br /> g ,��{I� <br /> -------------------------------------------------------...--------------------------------------------------------------------------------------.......------------------------------•----------•------------------- <br /> I hereby certify fbat 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) ---� - - - -------( f 9r Contractor# <br /> By------------------------------••----------------------------=--- - - ---------------------------------(Title)---•--&- ----- - ----------------- <br /> (Plot plan, showing size of lot, location of syste to relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - �� = v .<-r tom - --------------------------------- DATE.. T 1 ----------------------------- <br /> REVIEWEDBY----------------------•----------------------------------------------------------------------------------------------------- DATE----- •------------------------------------------•----•---- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------•------------ DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations---------------------- ------------------------------------------------------s---•--------�--•-•----------------------------------------------••------------- <br /> s 0,1k r--------ire._. ' lb--------5AVkI-------•--.[.'_. <br /> --------- ---------------------------------------•------------------------------- ---------------------------------------------------------------------------------------------------------------------------------:.... --- <br /> --------------------------------------------------------------------------------------•--••------------------------------------------------- --------------------------------------------------- --------------------- <br /> FINAL INSPECTIONtDate.------- r' ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB-9 RCVS SED 0.59 F.P.CG.2M 6.60 <br />