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4....................... ...... <br /> ................. ................................ ...... APPLICATION FOR SANITATION PERMIT Permif No. <br /> ..........­..............-•-••---------•--....... <br /> .........................­­------------- ---- (Complete in Duprica+a) <br /> uFf"ur Expires From.................... This Permit E I Year Date Issued1�-; s-� <br /> Date issued t. <br /> Application is hereby made to the <br /> San Joaquin Locat 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 /> JOB ADDRESS AND LOCATION-11AX.-S-10-4e.,------Q.......A.. J-1......... <br /> Owner's Name_ 73.,.;..a.22V./ <br /> ...jAC­214-110".-A.*-r4---------................ Phone.__.... <br /> Address......... <br /> ... ............. <br /> Contractor's Name. ....... ...................................................... <br /> .,ey A�, <br /> ---­----------- -------------------------------........... Phone. <br /> Installation will serve: Residanc6� <br /> jW Aloafri'ent House ❑El Commercial [I Trailer Court E] Motel @10-Other <br /> Number of living units: .......I t. <br /> I . Number of bedrooms -------- Number of baths <br /> Wafer Su ,F Public system Ej Cornmuni4 system 0 Private C] J.- Lot size ............... <br /> Depth to Water Table 1f"ft <br /> Character of soil to a:depth of 3 feet: Sand Gravel Sandyl­oa� E] ClayLoa <br /> , m'0 Clay❑ Adobe 93' Hardpan❑ <br /> Previous ApplicationMade: (If yes,date------ .......... No Ej- Now Construction: Yes J�' ❑No [I FHA A: Yes ❑El No <br /> TYPE OF INSTALLATION AND,SPECIFICATIONS: <br /> (90-le P-4 i�f—a4;;i ci;ispoor per;�fii;2 1i pu;U7 sewer is available a e Wl+hin 200 feet.) <br /> Septic Tank: Distance nearest w fl, <br /> /. ce -­------Distance from foundation...-/.-4. <br /> No. of compartments.... <br /> depfh' - ------ <br /> ------------­Capaclfy.-YZ <br /> Disposal Field: Distance from nearest well-f-O...-------Distatnce from foundation j.. <br /> U . 4j Distance to nearest lot line... <br /> Number of linei--l- I line „.Distance <br /> of trench....-Z <br /> of filter Material. -Jjr �" <br /> Type of filter nriafe;iial. Length of each � ­. .. <br /> ......'-.,-.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 /> ............. <br /> Cess ...............­­-Depth..-.... <br /> Pool: Distance arest well..___._..__....__Distance ................... <br /> ❑ r -----Distance from foundation...........142---�.Lfninq material.........*........................ NO <br /> Size. Diameter__._.__...._. <br /> .....De <br /> L <br /> Privy. Distance From nearest well... ................... <br /> fro '4earest building............ <br /> Distance to nearest lot 1ine'.__­.-.-.-.*.'.*--------------&---------- --------..Distance ni— ................. <br /> ................................. ...................... ............................................. <br /> Rernodefing and/or repairing (describe):.............. <br /> .......... .. ..... .................................. ...................... ...................­­ ......­­..............:......... <br /> ---------- ...........a , I <br /> ------------------^-11--- �F <br /> ........ ..................... <br /> .......... ......... <br /> ........... <br /> ­­ .................................................. ..............................................!.......... <br /> ................................................ .. ...................................................:­­.... <br /> I hereby certify that I have pr4pared this application and fha+the work will be done-in accordance with San Joaquin County <br /> ordinances. State 41aws. a d rules and regulations of fhe a Joaquin Local Health District. <br /> (Signed�.......... . ..... <br /> ............. .......................... <br /> .r ...........................(Owner and/or.Contra <br /> etar <br /> ................ <br /> ------------------------------------­* --------------------------- ...... ?.!.........................................--------­------- <br /> (Plot plan, showing size of lot, location of system in relation +*wells, buildings, be placed on reverse side <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__....__ <br /> ---------------- ATE...... ............. <br /> REVIEWED BY ------------------------------------------------------- <br /> ATE.... <br /> .. ........ <br /> BUILDING PERMIT ISSUED..........._..._.•-..-.-_.......-•-----•-•----------------- -----*----------------- ............ <br /> ....................... ............ DATE................................. <br /> Alferaflons and/or recornmendafions: <br /> ........................................................ <br /> .................................I...............-•-•---------------•_.._.• <br /> ---------*...................................... <br /> .........................................:........................­­....................................................................................;* ...... <br /> ............. ...........................I <br /> ...................­.­..............1-....................................... .­.......... ....................................­.......... .....................I......................I......... <br /> w..........................----•-.................................. <br /> ......................................................................... I.... ... . ........ ............­............................... <br /> c FINAL INSPECTION BY:...-_- <br /> ..................... ....... <br /> Date <br /> ................. <br /> .............. ........... ........ ............................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Warolton Ave. 300 West Oak Street 124 Sycamore Street <br /> Stockton,California Lodi,California Manteca,CaStreetfornia 205 West 9th Street <br /> F.P.ca, Tracy,California <br />