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------------------------------------------------------- <br /> _____________ ___________ _ ___------- <br /> --- --_ =. APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------- -- (Complete in Duplicate) <br /> This Permit Ex fres a Year From Date Issued Date lssued,lr .- �-� � <br /> I Application is hereby made to the San Joaquin Local Healfh District for a permit to con <br /> This application is made in compliance with County Ordinance No. 549. <br /> struct and install the work herein described. <br /> kJOB ADDRESS AN LOCATION---�f�D . 'iC <br /> S ,� / ' ,S S'Q / <br /> Owner's Name---- - ------­--------------- <br /> . <br /> --•------- <br /> - - --=-------------------------------- <br /> Address--•--, '^ r-- . Phone ,) <br /> 1-- <br /> Contractor's Name-------------, E� - ------ ----------- - ---------------------------•-----•---------------------•--- <br /> Installation will serve: Residence - ------ <br /> -- ------------ Phone.-.- 3fy�' <br /> ❑ Apartment House ❑ Commercial <br /> Number of living units: _�-__ Number of bedroom ❑ Trailer Court ❑ Motel ❑ Other <br /> _- Number of baths _ -. Lot size -...t <br /> Water Supply; Public system -- ��---C=/� ___________________ <br /> ❑ Communit system -"`----' <br /> Y Y ❑ private '- Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ---eft. <br /> ❑ Gravel [] Sandy Loam Clay Loam ❑ Cla <br /> Previous Application Made: (If yes,date.--__ Y ❑ Adobe ❑ Hardpan ❑ <br /> ) No [jNew Construction: Yes '' No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ <br /> Tank., ptic tank or cesspool-permitted'if�public-sewer=is-available-within=200-feet:) .__ <br /> Septic tank: r <br /> p Distance from nearest well - <br /> / -----.-_Distance from foundation--.40 ------Mater;af-/CF �D7C� � <br /> Lam" No. of compartments_--_- _ <br /> Size-- . `X��'---=---Liquid depth---- <br /> Disposal Fe{d: Distance from nearest weN� Capacity <br /> Disposal <br /> ..... Distance from foundation- -p <br /> Number of lines-------s v <br /> _. ---.Distance to nearest lot line.X_.--/�(IA/ . <br /> Length of each line_` <br /> Width of trench <br /> Type of filter material.- <br /> ._. �� I <br /> Depth of filter material `� <br /> Seepage Pit: Dis#ante to nearest well-------------- ��- Total length_-- <br /> Distance from foundation--------------------Distance to nearest lot line <br /> EJ Number of pits.-_.-__-____-.__-__-.Lining material_-__-_____- <br /> Cess ool: ----------Size: Diameter---- ---- ------------Depth <br /> - <br /> Cesspool: Distance from nearest well----_------_ ---------- <br /> t --.- Distance from foundation ----------------------------- <br /> El Size: Diameter--- ------.Lining material------------- <br /> Depth ------------------- -- -----------------. <br /> Priv i - -- ---- --------------Liquid Capacity Y= Distance from nearest wellY - . --------•--.gals. <br /> -Distance from nearest buildin <br /> El I XDistance to nearest loft lire <br /> ---------------------------------------------------- - <br /> ------------- --------------- <br /> Remodeling and/or repairing (describe):-__- - <br /> sv�- <br /> S - <br /> .-- ------------ <br /> - ----------- ------------------`-n--- ---'"= = . _411. ----- <br /> ereby certify that I°have prep rea d'fRis aPPI1 tion and that the work will be done in accordance with San Joaquin Count <br /> ordinances, State laws, and rules and-i•egulatibris of'A6'San Joaquin Local Health District. <br /> Y <br /> (Signed)------ <br /> die c <br /> ''-"-�—ABY,---------------------Snsi --------------------oflotfi - (Owner and/or Contractor) <br /> on rector) <br /> {Plot plan, showing size of lot, location of system in rela}io�to wells, buildings, etc., can be placed on reverse side). <br /> ---------------- ----------{Bile)_ ....... <br /> ---. - t - <br /> ) _ <br /> FOR DEPARTMENT FUSE <br /> APPLICATION ACCEPTED _- -.I �� <br /> REVIEWEDBY-------------------------- ------------ -------------------------------------------- ------ DATE � .�_S_- `• <br /> 7. <br /> BUILDING PERMIT ISSUED--------.-- <br /> ------------------------ <br /> ----- - ------ --------- <br /> ---- ------- ---- ------ -- -------- -------------- DATE-- --- - ---- ---- ------ -------------- <br /> -! <br /> terations and/or recommendations:- DATE ----------------- <br /> -------------------------- <br /> ------ -------------------- ---------------------- --- <br /> FINAL INSPECT! / <br /> - - - - - -- -- - ----- - - - --- Date--- .....1-�---- /o.-_'_� ---- �------ -- ----- �------=----. <br /> 1601 E.liaselton Ave. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> - ' <br /> 300 West Oak Street <br /> 124 Sycamore Street <br /> Stockton,California Lodi,California 205 West 9th Street <br /> Manteca,California <br /> F.P,co. Tracy, California <br />