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1t,c VOL:: s _ <br /> ` -------- -------- ------- ----------------------------- APPLICATION FOR'SANITATION PERMIT Permit No- _11�1_1q- J.6h <br /> t --------------------------------------------------------- <br /> k- {Complete in Duplicate) <br /> --------------- - I This Permit Expires 1 Year From Date Issued <br /> 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. S49. 4e. <br /> - <br /> JOB ADDRESS AND LOCATION..( <br /> ' r�-------��----- k.. <br /> Owner's NameC -------------- <br /> ` - --------------------- <br /> Address_._ <br /> Contractor's Name <br /> ------------------------ '�----------------------------------------------------- <br /> r'i,`!r�J_� _1�.y` ,---------------------- <br /> _2__<0 <br /> ��� ----•--- ----------------- ------------- --- ------------------- Phone. <br /> Installation will serve: Residence 1L�' .Hpartment House ❑ Commercial ' <br /> ��,�� ❑ Trailer' Courf�❑ Motel ❑ Other ❑ <br /> Number of living units: /Number of bedroom 24_ Number of baths <br /> _ Lot size _�lJC _ 5-------------------------- <br /> Water Supply: Public system --�'- I <br /> PP Y• y ❑ CoCammunit s st m ``-, <br /> Y-�y ❑ Private epth to Water Table�Q ft: <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan Previous Application Made: (if yes,date-------------- •.No b ❑ p ❑ <br /> - New Construction; 'Yes ❑ No [�}-• PHA%VA:�Y�es ❑ No []--•----` <br /> "`-TYPE -SPECIFICATIONS:--= <br /> Y (No�septic tank-or cesspool-perrnitted-if public sewer isilable_witkin_200 feet.) <br /> Septic Tank: Distance from nearest well---------_____--Distance from foundation'__________________Material_____--------------------------------- <br /> ------- <br /> -____.____-_-- <br /> ❑ No. of compartments----_. ------------ -- <br /> Size -- --Liquid-depth:- n------------- Capacity-- <br /> ------------- <br /> Disposal Field: Distance from nearest well--- :-fJDistance from foundation___ y <br /> --.__:x--__.Distance to nearest lot line---S__._.._____ (�} <br /> Number of lines___ g ,l__ !a Width of trench.. <br /> -___ ___________.Len th of each line___ � - _ f' <br /> - -- -- .___ T ----------------- <br /> Seepage <br /> --------------- <br /> Type of filter material lU".L:__'.Depth of filter material___I�------_ ----Total length__-._ ©- - _ (� <br /> ------------------I <br /> Seepage Pit: Distance to nearest wel!__-- --Distance from foundation___..___ <br /> �ti' -------_.__.Distance to nearest lot line_________________ <br /> ❑ Number of pits.-------.- s-----Lining material_- =_-_--___._Size: Diameter Depth------------------------ --- - � <br /> Cesspool: Distance from nearest well______________ Distance from foundation_.__._._.___..____.Lining material__.__------_-__ - <br /> - ------- <br /> ❑ Size: Diameter____.._//_------ -----_ <br /> Depth = Liquid Capacity -----------------------gals. <br /> •e ' a <br /> - - ----------- <br /> Privy: Distance from nearest well-.____.____ __---------------------------------------------------Distance from nearest buildin <br /> -------------- <br /> g <br /> Distance to nearest lot�i'ine_:�•_._•._r:--__---_- <br /> Remodeling and/or repairing,•(describe):-----�--B,rjJ/�.!JZ------ A"' <br /> -----•------ <br /> �� � �!y�� ��.5/ _-------- <br /> °:= ---------------------- <br /> ----------------------------------- - - <br /> ----------------------- <br /> ---------------------------------------------------------- -------------------------------------------------------------------------------------------- <br /> --------------- ------- <br /> I hereby certify that 1 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-Distr'ic`t, <br /> S-•i ned�B)--------- <br /> ---------------------- <br /> y: y --------------------�------ <br /> - <br /> � --------------------------- <br /> _; <br /> .'. ---- --- ;`- <br /> ------------------------------------ r and/or <br /> .. <br /> Contractor) <br /> � 4L (Tale)-�. ` <br /> -_ �. .. - : <br /> (Plot plan, showing size of lot, location of system in relation to we11s, buildings, a#c., can be placed an reverse side). � ---- <br /> ow <br /> - <br /> f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- <br /> .._ - <br /> . - <br /> . REVIE <br /> -----•---- DATE--------- f / <br /> ------------------------------------------------- <br /> WED BY :_ --- -------------- ----- -------- ---------------------- ---•-- DATE--- -------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------ <br /> A teratioiis and/or recommendations:___---------- <br /> - -- -- ----•------------- -- <br /> f -•------ _-- <br /> -«m. ..— ---------------- -•-- <br /> ------ I <br /> ----- -------------------------_.� - <br /> -------------- <br /> -------------------- -------------- --------- ; <br /> ------------ <br /> ------------ -- <br /> • <br /> FINAL I - -------- - -- --- --- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601,E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th street I <br /> Stor�cCk,ton,California Lodi,California Manteca,California <br /> 3 Tracy,California <br />