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FOR OFFICE USE: <br /> -'_ fes__________________ APPLICATION FOR SANITATION PERMIT Permit No. ao. ....ra <br /> ---------------- [Complete in Duplicate) S= 6 �. <br /> Date Issued /_-____________ <br /> ------------------------ ------------ This permit Expires 1 Year From 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 <br /> No..�549. 'a <br /> r JOB ADDRESS AND LOCATION--------•�67.3�Z- ------- <br /> Owner's <br /> -.-� r /��� � �'� = <br /> f" _ <br /> 1�1,C?�C ��eJ 1 3 ..� <br /> { Owner's Name-------��~�--.----- -- - •----- !?.�.5-[Pl'12--------{----------------- <br /> Address__ <br /> ------- ------- ---�----�--- <br /> tAddress.----,----------,3..2-`%------� ..�_f���..�.�N-----.Z.it/-----------------------------'------------------- - ----------•--------------------------------- <br /> Contractors Name__.-- P. Phone -.��f <br /> Installation will serve: Residence IK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --!__!Number of bedrooms _,-3- Number of baths Lot size -------- <br /> I Water Supply: Public system El }Community system ElPrivate ;K Depth to Water Table 4 ft. <br /> Character of soil +o`%epth of 3 feet: Sand ❑ Gravel ❑ - Sandy Loam ❑ Clay Loam g Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Applica+ion Made: (If yes,dcite____-------_--------) No jR New Construction: Yes ❑ No a FHA/VA: Yes ❑ No R <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.] <br /> Septic Tank: Distance from nearest well_____________ __Distance from foundation--------------------Material-----------------------------------r----------- <br /> .. <br /> ❑ No. of compartmenfs--------------------------Size--------------------------------Liquid dkpth------------------------ -Capacity---------------------- <br /> Disposal Field: Distance from nearest well___-------------Distance from foundation--------------------Distance to nearest lot line_________________ <br /> Number of lines----�__________ ______________Length of each line_,w _ ` <br /> ,� Width of trench - •------------- •-- <br /> Type of filter material ,�°�� _____Depth of filter ineterial.._.,o,?"-._____..Total length_______ L-��------- <br /> - r � f � <br /> Seepage Pit: Distance to nearest well...�a a_.._.__-DistancI- le m foundation- -______- Distance to nearest lot line_ <br /> Linin material r Size: Diameter_' __._._Number of pits g .._._.Depth---a.4--- ----------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation-----.--------------Lining material____.-________----------.__________ —� <br /> ❑ Size: Diameter------- --------------------------- -Depfn---------- ------------------------ -----------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from 'nearest well----------------------------- --------------- g�-`-- ------------------ <br /> Distance from nearest buildin ------ <br /> Distance to nearest lot line______ ________ _ ------------------ <br /> --------------- <br /> -----------• <br /> and/or repairing (describe):.____ __------______ ,- t- ------------------- <br /> Remodeling 'S <br /> -------- ------- <br /> -------------------------------------------------------- -------------------­----- ._---/--------- \---------------------- If,----------\------•--------------------- --------- <br /> --------------------------------------------------- <br /> -------:----------------------------------•----------- <br /> ---I---- -------- ------------------------------/------------------\---•------------------ ---------- -------------------- - -------------------- <br /> --- ----------------------------------------------- - - - - -- <br /> I hereby certify that I 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 Jopaw Local Health District. <br /> € ,�, ..S . . t3 ._ „4 �"�O ner and/or Contractor] <br /> (Signed)----------- -------' 1 --- <br /> l ---(Ti+lej �� � <br /> By:---------- ---- ------- ------------ -: - - ---------t---------- <br /> (Plot plan, showing size of lot, to ion of system in relation to wells,�.buildings(etc.,�n{be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY t/ 1--------------- ----- DATE-------------Zl ------------------------- <br /> REVIEWEDBY---------------------------------------------------------------------- - --------- ------------------- --------------------- DATE----- ------------------------------------------------------ <br /> BUILDING <br /> ------ ---------------------------------------------BUILDING PERMIT ISSUED---------- ---------------------------- ( DATE----------------------------------- ------------------------ <br /> Alterations and/or.recommendations:------ F <br /> ------------•------------ ----------- -------- ----- -I-r--------------------- -------------------------------------.---------------•-•----------------------------------------- <br /> - .---- ----------------------------------------------------------------------------------------------------------------- <br /> F <br /> xk _.. - _________________----------------------------------_------------------------------- <br /> FINAL INSPECTION BY:..--- ----------------- ----------------- Date------- <br /> ------- ----------------------------------- <br /> d <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 245 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />