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4 r i�: l? 1 <br /> APPLICATION FOR SANITATION PERMIT Permit-No:..''-. <br /> (Complete in Duplicate) ' <br /> Date issued _7f.?r35 <br /> 'fes <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein`desscr.ibeid. <br /> This 6pplication is made in compliance with County Ordinance No. 549. <br /> JOBi!ADDRESS AND LOCATION --------% r�' ,• e 7!'_ — <br /> _41 <br /> � ---- -------- <br /> Owner's Name ------------ -�. `..._ _ 1L�_. -lj►one----- ----- --++ <br /> Address----------------------------------------------------- / , <br /> ------------ <br /> Contractor's <br /> �r <br /> Installation will serve: Reside &---xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_., _ Number of bedrooms _Number of baths _:__ __ Lot size ____Z_:.0---x_-j- ------------------ <br /> � <br /> Water Supply: Public system [],--Eommunity system ❑ Private ❑ Depth to Water Table -------- ft, <br /> `f <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe❑_�fardpari <br /> ii <br /> 1 Et� <br /> Previous Application Made: Yes Jo El New Construction: Yes Q o ❑ <br /> 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 wall___ ------___....Distance from foundation__.F_____r---------Material----------------------.--------------._-________- <br /> No. of compartments---------- ------ --------Size--------------------------------Liquid depth--------------------------Capacity....------------------ <br /> Number of lines---------- we stance from foundation____ _._____-Distance to nearest lot line.__a Q_._... <br /> Disposahnid: Distance from nearest/ Length of each line------ - 4._�_._.';------Width of trench________c=4"­....... . .. <br /> Type of filter material---- VIk pth of filter material_.__`__ __�. Total length-------- ¢_s__________________ <br /> r Seepage Pit: Distance to nearest well_._ .. Distance from f'unclafior t�--____.Dista c to nearest lot line___Z0__�_ <br /> __Linin material_ Iegwq- Size: Diameter___. be th. ___.____ <br /> Number of its_______ t <br /> Cesspool:. Distance from newest well_________________Distance from foundation.."_.__._.________ Lining material-___.._.____ .---------------------- <br /> � - Size: Diameter------ ------ --- ------ --r-----Depth---------------------------------------------'-------Liquid Capacity-------------------------=•--•gals. <br /> Privy Distance from nearest well-------------------------------------------------Distance from nearest building--------------------._________.._____..._. <br /> Distance to nearest lot line-- -- - ------I------------------------------------ -•-------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe): <br /> ( (describe):-------------------------------------- --------------------------------------------------- ------------- <br /> -------•-----=-----------------•---------- <br /> ------------------------------------------------------------------------- A ----- <br /> ----------------------- <br /> ------------------------------- --------------------------•-------•--------•-------------------------------------••---.....•-••-------•---------•-•---••---------------------•---------•---••-------------------------- <br /> "� § <br /> -----------------------------------------------------------­- ---------------------------•------------------•------------------- ------•---•-•-----•--••-------------------------------•- ------•----------------------- <br /> iI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> .,ordinances, S ws, and rulrm?d&ryrb[ffs o_f, the San Joaquin Local Health District. <br /> S20c Tank.Service ; ,. <br /> (Signed)------- --t-2t35-So-dorado---}IO-2-30 =; - -- ----•--•----------- -------------•------------(Owner Contractor) <br /> - -------------------- <br /> ..--=Stockton, Calif. I <br /> " ........... �_ Tit e -------- <br /> By:................. ( } <br /> (Plot plan, showing size of lot, location of system in relafion to v4s, buildings, etc., can be placed on reverse side). - <br /> I <br /> FOR <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------- - -C `_w '� `--- ------------------------------------------=---- DATE------- <br /> REVIEWED BY---------- --------------------------------•-- <br /> ---------------- z . i -:-• <br /> ------- ------ DATE ------- <br /> BUILDING PERMIT ISSUED----------------------- ------- DATE----.---. �__7_ <br /> �- --- - ----- --------------------=------------------ -------------------------------- <br /> Alterations and/ar.recommendations:--�=-- ---- ------------=--------------------------------••------------------------- ---•-----IQ•----------••--•-•----- <br /> E <br /> ________________________._.___. _____+. ___ .____ ._____ �____..___.----------.----------.-_. ___.__________----_--.-.._____________ ........_______.-... <br /> __. <br /> -----------•----- - -- ----- --- -------- - ----------------- --------- - ----- ----- <br /> ------------------------------------------------------ ---------- -------- ----- <br /> FINAL INSPECTION BY:./``_- . <br /> `" " ------ _4............ - -- ------ Date -. - ------- _ : r <br /> j; <br /> 1SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wost Oak Street 132 Sycamore Street 814 North "C" Street <br /> 6 Stockton, California Lodi, California Manteca, California Tracy, California <br /> F <br /> 2M 145 6 ATw.oa 32-54 <br />