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-n-.FOR OFFICE USE: <br /> __-------II__- APPLICATION FOR SANITATION PERMIT Permit No. <br /> - ----------------------------------------- -- -- <br /> ---------------------------------- (Complete in Duplicate) <br /> Date Issued <br /> ------ -- ----— - --------- --------------------- This Permit Expires I Year From Date Issued <br /> a 7 <br /> d <br /> Application is hereby made to the Son Joaquin Local Healfh District for a permit to construe install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 4P <br /> A�T �P <br /> JOB ADDRESS AN LOC --------------- - ---------------------------------------(I------------------------- <br /> ... ..... <br /> Owner's Name-------L+ - ------ --- ------------- -------------------------------------- Phone------------------------------------ <br /> 74 <br /> Address-------------- _---------------_- ------ & ---------- ---------------------------------------I--------------------------------------- <br /> Contractor's Name LkT__� <br /> --------------- ------------------------------------- f <br /> ----------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Resid5nce 0Apartment House F] Commercial E] Trailer Court E] Motel Other ❑ <br /> Number of living units: I---- Number of bedrooms -I' — Number of baths 7— Lot size ------ [.'_...__•____________________________I---.-- I <br /> dp <br /> --------------------------I------ <br /> ill 0 C <br /> Water Supply; Public systemommunity system D Private [Depth to Water Table _C5--- ff. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam E] Clay Loam E] Clay C] Adobe D—Hardpan ❑ <br /> New Construction: Yes E]—No E] FHA/VA: Yes E] NaPrev;ous=A plicafion,Mad . flf,yes,date__._.---- - -----) N o ET <br /> P El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or ce'S:P061 permitted'if.public sewer is available within 200 feet.) <br /> Septicjank: j&- Distance. rom nearest well__---------------Distance from f6undafion----------------- -Material--------------------- --------------------------- CIF <br /> 1 No. of compartments--------------------------Size--------------------------------Liquid depth-------- ------_Capacity--------------------- <br /> D;sposal Field: Distance from nearest well...5.0----Distance from fouriclatiorl-10___-_-__-Distance to nearest IoUine_,5_�------- <br /> 11 0 <br /> Number f lines)"- - Length of each line--------- -------Width of french 0-. <br /> ------------------------ <br /> Type of {Iter material.------ of filter material------/S-----------Total length------- ---------------------------- <br /> Seepage Pit: Distance��to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-______________ r <br /> El Number" f pits----------------------Lining material----------.-----------Sze: Diameter------------___-_-.----Depth-.------------------------------ <br /> Cesspool: [�stanceD .11;from nearest well-----------------Distance from foundation-------------------Lining material----__--____________________-__-.-_ <br /> --------------------------- <br /> ' <br /> ❑ <br /> Size: Dia'reter--------------------------------------Depth-- ---- ---_ ------------------------Liquid Capacity--------- - - -----gals. <br /> Privy: Istance!from nearest well------- ------------- ---- - -------- -Distance from nearest building--------------------------------------- <br /> Distanceffonearest lot Iine----------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairin I describe)_____________ t 5_T-I-P ------------------------------------- ------- <br /> ---­---­------------- -----------------111------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- <br /> -----------------------------I-----------------;-----------------------------• --------------------------------------------------------------------------------- ------ -------------------------------------------- <br /> ------------------------ -------------------------l-------------------------------------------------------------------------------------------------------------------- ..........­-1------- ---I-------------- <br /> I hereby certify that I hav 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 ��14C I-ell ------------------------------------ ------------------------------- --------------------------------------------------(Owner and/or Contractor) I. <br /> ly(Plot plan, showing size of lot, of--------------------------------- <br /> location system in relation to wells buildings, etc., can be placed on reverse side). <br /> FOR DEP C�MENT USE ONLY <br /> APPLICATION ACCEPTED :3 <br /> -- •--------- r DATE - .... . <br /> - <br /> REVIEWED BY---------------------- ---- --------------------- ------ DATE-------------------- ---------------------- <br /> A <br /> ---------------------------------------- <br /> I. BUILDING PERMIT ISSUE ------------------------ --------------------------------------------------------------- .... DATE--- ----------------- <br /> Alterations and/or recommerildations:------ ---------- - --------- ----_-------- - -----------------• -------F----------------------------------------------------------------------- <br /> ------------------------------------------------ ------------------------------------------------------------------------------ ---------------------------- -------------------------------------- <br /> --------------------------------------------------------I--------- ------­­-------------------- ---------- ------ --Z---------------------------------------------------=- / ------------------ ------------------------- ------------------------- <br /> :------------------------------------------------------------ ------------ --------f� <br /> ------------- ------------------ ---------------------- ........ ------- ----------------- - ------------ --- ------------------------ ---------- ----- -- - --------------------- <br /> 5 -576,e <br /> FINAL INSPECTIO -C--------- ---- Date-------------- ---- -- ------ ------------------------- _ � 1;_'''y: ir <br /> - <br /> AN AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.-Na:elton Avg. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California i1Ma­ntbc'a_California Tracy,California <br />