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SANITATION PERMIT Permit No:Y..: ",r� <br /> 1. .... <br /> APPLICATION FR SA <br /> ----- -------- ----------------- a .�- <br /> ------- -- (Complete in,Duplicate) .. s ¢. - k Date'Issued <br /> " - -- __-.- ,.- _._ --.-__ _ - �ThQ .Permit Expires 1 Year From Date ate Issue _ <br /> Application is hereby made to.the San Joa um Local Healfh District for a ermlt to constr ct,and install the work herein described. <br /> PP <br /> This application is made in compliance with County Ordinance=No. 549.x' <br /> f ---------- <br /> JOB ADDRESS All N ----- T i ----=- - ----•----- <br /> a.._.�__. - ------ .:. -__ Phone- <br /> ---------------- <br /> t <br /> h <br /> �. . <br /> ------------------------------ <br /> ------- <br /> �f��- one <br /> 6p • <br /> Owners Name..__ - - - - -•- _ <br /> =------ <br /> 4 <br /> Contractor's Nama ,. i = P <br /> e. <br /> -• s x � <br /> Installation will serve: Residence Apartment.House ❑ aCommercial ❑ Trailer CourF ❑ Motel ❑ ter ❑ \ <br /> p r --o <br /> Number of baths _ . Lot siie --oil P- ------ <br /> Number of living units- ---- Number.of bedrooms'-,00-__ _ t <br /> Water Supply: Public'system ❑ CO ' Munity yst ❑ Private X Depth to�.Water Tal?1e.5�d ft. <br /> i; t <br /> Gravel Sand Coom ❑ Clay:Loam ❑ Clay ❑ Adobe 11 Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑" � �m , <br /> Previous Application Made: (If yes,date----- --_-1` No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No [I <br /> r r <br /> I' TYPE OF INSTALLATION AND SPECIFICATIONS: 3 ` <br /> lA(No','septic-tank or cesspool permitted if 'public siiwer is available within 200 feet.) <br /> D Material_ ----------- <br /> Septic Tank: Distance from nearest wel. D-----_Distances from foundation___ <br /> '7�.�(-`a�-�14_.Liquid depth--- ---- <br /> - Capacity .. j.4 <br /> No. of compartrnents__, ----------------Sixe____ __ f <br /> Disposal Field: Distance from nearest well_sSa_`�-_._Distance from founndation__l _.._._.Distance to nearest lot line S'_..______. <br /> Number of lines-----o2-___-- ----------- <br /> _____._" _=-Length of each lined------- Width of french' - -5�-�-----�-----••• <br /> T e of filter_materlalj _ � De th of,.filter materIs "'�`-- Total ,len th--------- --------- -------=---- <br /> yp p ial_. e9= g . t , <br /> i See a rwell/016 , It <br /> p 9e pi}; Distance to nearest _____-----:Distance from f nclation._ _ Distance to nearest lot line____ ------ <br /> Number of `Its.__ _. Linin rnaterial- -size Diarrieter._. -- '�epth___c> _•55___---------------- <br /> N <br /> _________ ___ �0 <br /> K? �- g 3 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.____.___.__-_____..Lining material___-..--.--..-_____.._.__...._____ <br /> = Depth - -•------�.-.:�:; :_.Liquid Capacity gals. s <br /> ❑ Size: Diameter-----------•----------- ._ .. <br /> Privy: Distance.fr8m nearest well-------------------------------------------- Distance from nearest building---------------------------_ = <br /> ❑ - -------- S <br /> Distance to nearest`lot line-------------------------------- <br /> ...r 4 - • ' <br /> Remodeling and/or repairing <br /> ----------- <br /> ----------------------------------------------- ------ <br /> -------------------- <br /> ----- <br /> IF <br /> f ..�.t� = ------------------------------------ <br /> - ------------------------- _---- ----------------- <br /> ------ <br /> ------------ ' <br /> ____ ________ _______________ <br /> ---------•--•------------ <br /> 1 hereby certify that I have repared this application and that the work will be done in accordance with San' Joaquin County <br /> ordinances, t to laws, a Cf rule 'and ri gulafions4ofeSan Joaquin Local Health District.5i ned -- - --� - - ---- <br /> --------------------------------------------------------- -- (Owner and/or Contractor] <br /> t (Signed) -- -•r- - ------------ - ------- <br /> c i ------ (Title) <br /> By:.-•------------------:-------- <br /> I (Plot plan, showing size of lot, location of system in rel tion to welis, buildings, etc., ca.n be placed on reverse side). <br /> I FOR DEPARTMENT USE ONLY a <br /> -------------- DATE--------` `-��'------------------------- - <br /> APPLICATION ACCEPTED BY-------------------- ------------- ' <br /> REVIEWED BY t <br /> DATE--- -- ------------i-------- ------------•------- <br /> t - <br /> DATE <br /> BUILDINGPERMIT ISSUED--------------------------------------------- -----------------_:------------------------ --------, <br /> ,L_ �,q <br /> _ '_-. <br /> --------- <br /> Alteratons�..and/or recommendations::--- 4- --.�-�--�-j-- -�---�-------y-�-----Z--��� <br /> ------ <br /> ------------ ­­1__1'­-4f _rte- _.`•__7_�.__ <br /> -- <br /> _ --- -_ f --------------------- <br /> ---- <br /> 1-----------17n_7- --- ----- --------- �� <br /> ------------------------------------------ <br /> FINAL INSPECTION BY------------ ---------- <br /> ��" -- Date--- -----..._.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.lfaselton Ave. 30o west Oak Street 124 sycamore Street 205 West 9th Street <br /> Stockton,California I Lodi,California Manteca,California Tracy,California <br /> CS 9 REVISED A-59 3M 3-'63 F.P.CC. ��~ <br />