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FOR OFFICE DISE: * - <br /> ----- --------------------- ------------- -- ---------- <br /> j APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------- ------------- - -------- - (Complete-in Duplicate) <br /> This Permit Expires 1'Year From Date IssueDate Issued _,3 _ <br /> ----------- <br /> --------- - ----- ----------- d 2� - tam w 7 <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 <br /> Ordinance No. 549. <br /> I ­30JOB ADDRESS AND LOCATION----fir--�Dom' = 1 - :_.I_ _._.. 0 ' <br /> rPhone-----------=-----------=--------•--- <br /> Owner's Name.------- -���--------- �-E°- ----�-------•--••-•----••-•-- ------ ------ -- -------- ---------- -, -- --- ----- <br /> I l Address <br /> Y_L <br /> Y-3--------- <br /> Contractor7sti __Nc_ N <br /> - _ . fl_ ._ . . . _GG----------- Phone----------------------------------- <br /> Installation <br /> ----- ------Installation �! <br /> will serve: Residence ❑, Apartment House ❑ Commercial ❑ Trailer-Feaf+-Er" Iotel ❑ Other ❑ <br /> Number of living units: __ Number of bedrooms'---Z—Number of baths -_L___ Lot size _jJ; _._.C_---------- --------------- ID <br /> i Water Supply: Public system ❑ Community system ❑ Private 2--_Depth to Water Table 3.5_ ft m <br /> Character of soil to a depth of 3 feet- SandGravel ❑ Sandy Loam E] Clay Loam E] Clay [:1Adobe ❑ Hardpan ❑:R, ,, <br /> t Previous Application Made: {if yes date_- ..:"'')' No�f" New Construction: Yes � o ❑ FHA/VA: Yes ❑ No LI <br /> L TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> �(No septic,tank or cesspool permitted.if public sewer is available within 200 feet.) <br /> .� - �.. _ ..-- <br /> T <br /> Septic Tank: Distance from nearest wnk____SP-----Distance from foundation—'10 . ._...Material CDnIC_ _t=T <br /> No. of compartments__-_.- --...__Size?~X-a:___ -..Liquid depth_ .]-. _ Z _.Capacity----_����..__- <br /> . <br /> Disposal F' Id: _ Distance from nearest well:.:57`—__�.-._Distance from foundation____._._ ._ <br /> _.___._.Distance to nearest lot line_____________--- <br /> . <br /> Number of lines.-------------�:----------Length of each line-_.5�.�_-.5 ---Width of trench-------2. �---'--------- <br /> ! Type of filter material__F C. ---Depth of filter material----..1.. ...........Total length----------_� _ _ ._____..________-.- <br /> Seepage Pif: Distance fo nearest well----------::----------Distance from foundation--------------------Distance to nearest lot line.._---:.__._--.._ <br /> ❑ Number of pits.-- -------------- Uning material---- ------------- Size: Diameter--------- -- ---------Depth---------- ---------------------- <br /> t <br /> Cesspool: Distance from nearesf,w_ell...---------------Distance from foundation---------------- ..Lining.material------------------------..-._-.------ <br /> ❑ Size: Diameter'-- --------- --------------.-Depth_ ------------------------r---- --------------------Liquid Capacity-------------- -------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building........_.-----_----------_--:.-..--..._. <br /> El Distance to nearest lot line ------------ ---------------------------------------------------------- ------------------ <br /> ----THRd t---llr[L��' <br /> Remodeling and/or repairing :-------G--- - <br /> QWeA <br /> ----------------------- ----- <br /> F' -----.7, <br /> =►_R-•©------------- <br /> _______________________________:_---.-----_._....----_-______---_---__-.___ <br /> ________________________________________________' . - ---------------'-'-'-------•-'----'-'----'---------------'----'------- ------- <br /> _ _ ----------------------------- --------------------- --------- -------_---__ --_ <br /> I - <br /> hereby certify that I have prepared this application and.+hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rule and regulation of the San Joaquin Local Health District. <br /> (Signed) Q d ------ ................... ------ - ---------------------------- ----- --------------(Owner and/or Contractor) <br /> 9 --- -- - <br /> Piot plan, showing size of lot, location of sys+em in relation to�- :. - T , (Title)__.__d _ .revers . _...-... <br /> -------------- <br /> [ p wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY ° = Q - ------ ----------- ------------------------- -------------- DATE-- -------5.-',/577_67,_---------------- <br /> ------------------t�_DATE......... ----------------------------------------------- <br /> REVIEWED <br /> 5.-',/5 7_ 7_---------------- <br /> REVIEWED BY--------------------------------------- .................................- - ------------------ <br /> I __:,DATE <br /> BUILDING PERMIT ISSUED-------- -- ---`---- --------------"-------------------------------------------------- DATE <br /> 3 - • <br /> Alterationsand/or recommendations:...... -------------'- --------------------------------------------------------- ------- -------------------------------------------------- <br /> ------------ <br /> 4. ------------------------------- <br /> «.t <br /> ------------------------------------- <br /> ------------------------------------------------------------------------' - ---------------- . ------------- ------------------------------------- <br /> ----------------------- <br /> ------- — --------------- <br /> ................ ..----------"---------_ _. <br /> r <br /> Date........t7--."• ------ ' <br /> FINAL INSPECTION BY ;?44; - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street w <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 .Vanguard Press <br />