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FOP,OFF14 USE: <br /> A" <br /> ----------------- -----....-------------------------- <br /> ` APPLICATION <br /> ---------------------------------- <br /> APPLICATION FOR SANITATION PERMIT PermitNia. <br /> ----------------------------------------- --------- ...5.....3 <br /> .... <br /> - ------------------------------------ (Complete in Duplicate) Date Issued <br /> .......-------------- -------------- - --- -- ------- This Permit Expires I 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 No. 549. <br /> � <br /> f <br /> JOB ADDRESS AND LOCATION----------_? ?A--------------------J_ le.,O,-/------ 7?A-V,4�7 ----------------------------------------------- <br /> Owner's <br /> ------------------------------------I--------- <br /> Owner's Name-------------------------------- ,ep e:-V-------d2—--------_------- ------------------------------------------------------------ Phone------------------------------------ <br /> Address----- ----------------- &------------------- ----------------------------------------------------------------------------------------------------------------- <br /> ---------------- 15-_` <br /> Contractor's Name-------------- -/----0 --------- --------------------------------------------------------- ---------------- Phone----------------------------------- <br /> Installation will serve: Residence q-1-partment House E] ' Commercial [] Trailer Court E] Motel [3 Other [I <br /> Number of living units: ----/_ Number of bedroom._ Number of baths/--- Lot size ---------67).-- ------------------ <br /> Water Supply: Public system E] Community system El Private E] Depth to Water Table A.57-7- ft. <br /> Character of soil to a depth of 3 feet: Sancl-�Gravel [] Sandy Loam E] Clay Loam E] Clay 0 Adobe E] Hardpan ❑ <br /> Previous Application Made: (If yes,date .:----___-..._..J t,No [0,-,<�w Construction: Yes L;_-H-tro FHA/VA: Yes 23-� o El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS, <br /> (No septic tank or.cesspool permitted if-public seNfiir;.is available'within_200.feef.)� <br /> Septic T k: Distance from nearest well'-so--- Distance from founclation/V!--------Material-----Aw-4:7141--- --- -------------- <br /> Ekl�� No. of compartments Size__3X_1___K_�57_ -Liquid dep,fh--,- Capacity._11160-V------ <br /> E. CH&N O(Vi. <br /> Id: D�stance from nearest6w� 1. n <br /> DisposalF e�ICC _ Dista ce from fou'dation--- --------Distance to nearest lot line___ -- ----- <br /> idfh ren <br /> th <br /> t <br /> g <br /> t W of ---- <br /> Number of lines----------- ---------------------Le th of each �ine------7-4. Width of trench.__-*__.W --- ------ <br /> ye th of filter <br /> It I Tot,I _A. j <br /> Type of filter material---- th of fil Iter material--- length--_._41--Q--------F,=- <br /> f, is 10 <br /> f t T, <br /> Seepage Pit: Distance to nearest well----------------------Distance founclaf ion-------------------Distance to nearest lot line----- <br /> ❑ <br /> Number of pits-- I------------------Lining,material---------------------- - Ize: I ----------------------- --------- ----------------------- <br /> Cesspool: Distance from nearest weki------------------Distance from foundation---------------------Lining material-_-.-_.-.-----.----------------_---_ 151 <br /> ❑ <br /> aterial---- -------------------------------- <br /> El Size: Diameter--------------------------------------Depth---- -----------------------------------Liquid Capacity------ r------------------gal <br /> Privy: Distance from nearest well----__---- ------------_________________________Distance from nearest building---_------.--------__ <br /> ❑ Distance <br /> uiiding---------------------Distance to nearest lot line---------------------------- ---- --- --------- ------------------:------------------------------------------------ -------------­----------- <br /> Remocleling.ancl�/or_repairing {describe}:---- ----)V-4,0---- 7,j1 - ------—----------------- --------------------------------------------------------- <br /> --------------------------------------- ------------- ------f <br /> ---------------------------------------------------------------------- ----------------------------------------------------------------- <br /> A4 ---------------------------------- <br /> -----------------------------r-IR-0 <br /> ---------------------------------------- -------- --------- - -4------ <br /> C T�y----5t:wF_T�ls------ ----P_Pwry r:�------FD_R------Thll_j_!�, <br /> --- I sz---------- -----A R F__Jq------WR_ffN__. AN.N. b_ <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, :Sflaws, and le and regulations of the San Joaquin Local Health District. <br /> all� t� les <br /> --- -- ----------------- -- ----------------------- ---------------_---------- ---(Owner and/or Contractor) <br /> (Signed)---------- ---------------- - <br /> ----------- ------------------------- --------------- <br /> By:------------------ ------------------{Title)___ ------- <br /> n' S- -ise <br /> (Plot Ian, howing s _jo lot, location of system in relation to wells-, buildings,**etc., can be place d on reverse side), <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ---- -------------------------------------------------------------------- DATE--- _2 <br /> 7--- --- <br /> - --------------------- <br /> REVIEWEDBY-------------------------------- - ------ - - ------------------------------------------------------------------------- DATE--------_-----7t:__:--------- ------------------------------- <br /> BUtLDING PERMIT ISSUED---------` —---------------------------------------------------------------------------- DATE-------------------- <br /> Alterations <br /> ATE--------------------Alterations and/or recommendations:-------------------------------------------- - ------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------- ------------------------------- ------------------------------------------------- ------------------------------------------------ <br /> -------------- -----------I-------------------------------- ---------------I-------------..-.L.----._-..____..--.-------------------_..__.---_-.- ----- -- -------------- ------------------------------------------------ ------------------------ ------ <br /> :---- --- - Y)------------------ ------- ----------------------------------------------- <br /> ------------------------------------ - ------- - --- - V----- ----------------___.._--._---._-_----- <br /> I <br /> -m------------------- <br /> 7– <br /> ... . .................. ........ <br /> FINAL INSPECT - -- Lam/ ------ --- --- Date------ ------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> P-Pxa- <br />