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FOROFFICE-USEt- ;i <br /> ---------------­---- --- -__, APPLICATION FOR SANITATION PERMIT Permit No. • - ._ <br /> -- --- ---- ----------------- <br /> ---- (Complete to Duplicate) -� <br /> --------- This Permit Expires 1 Year From Date Issued Date Issued __ a/ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the workl�ere�i� describ <br /> This application is made in compliance with County Ordinance No. 549. 1"hm <br /> JOB ADDRESS AND LOCATION. ��ur ��'J`��7� /`-r''----------------------------------1_4 <br /> Owner's Name---------� ( 1-1C...---------�4-• � �--n---------------------------------------.-- ----------------------------e--- Phone----- -----------------------•-- <br /> Address--------------------------------- ,dL- l] .. -:_ --- <br /> // ff <br /> � t ------------------------------- --••------------------ <br /> Name__________ <br /> �•- �- - -`� --------------•------------------------ - --- -•- - ---- Phone....----•-•-----•• ----- � �----- - ------------- <br /> Contractor'sInstallation will serve:—Residence-�artment-House ❑--Gommercial-O-Trailer+•Court-❑- Motel-B .Gther g — <br /> Number of living units: ---/-t-Number of bedrooms ,;,,,,.Number of baths j.._ Lot size --------7o —.�I_C-_'_C_/10* <br /> _.- <br /> Water Su I :_Public_s sterm- , Comlunif, _s stem_. ]-.Privat6- ! De th to Water Table AV_ ft. a/*_1 �J�I� <br /> ,pP Y Y Y Y ❑ ,y,0 P � <br /> Character of soil to a depth��of 3 feet: SandGravel 0 Sandy Loam'Q Clay Loam ❑ Clay ❑ Adobe [❑ Hardpan ❑ <br /> f - <br /> Previous pplication Made: !(lf yes,dote----------------_--I No New Construction,,: Yes ❑ FHA/VA: Yes jj_-No ❑ <br /> TYPE OF�l INSTALLATION AND SPECIFICATIONS: <br /> _,.W R_, ic(No sept ,.tank or` �ce�spoiol_p2errmitfed if public sewerjs available within 200 feet.) <br /> Septic Tank: Distance"from nearest.well-..,S'V ---Distance from foundation_ 1_ Material- <br /> I ]�F No, of compartments_ -.__� -------!___Size___ TLiquid depth_- -,cam _____-_Capacity_^_,--o--- <br /> Disposal Fie .• Distance;;from nearest;welL_�_*_a:._Distance from foundation./O---."j-.Dis#ante to nearest lot line--_,S________... <br /> [(] Number 'of lines------a r------ •__--_- "-.-.,Length of'each line_7,--_� -------Width of trench____ �--!-_-______-__- _ f <br /> t <br /> -- - : ------------------------- <br /> Seepage <br /> Type of filter material /-� Depth of filter material___,�f',�_-_______-Total length__���_ � <br /> r � <br /> ,Pit: Distancel•to nearest well______________________Distance from foundation--------------------Distance to nearest lot line-----------_----_ <br /> ❑ Number of pits----------- ----------Lining material-----------------------Size: Diameter-----------------------.Depth-----------------_--------------- <br /> a ;r t <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----.........-------Lining material-- ____--____-_____________-__. <br /> ❑ Size: Diameter----------- `:__:_W= —" Depth--"---- ---- —=-__ _- _=--- ---_Liquid Capacity.:.'-----------------------gals. <br /> Privy: Distance,.from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ; <br /> Distance to nearest lot line----------- <br /> Remodeiing and/or repairing (describe):---------� . ------- ----------------------------- <br /> I <br /> --------------------------------------------------------------------------------------------- <br /> I <br /> A <br /> t -�1 hereby certify that I hwe prepared Ai plication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law , hules and re of f the San Joaquin Local Health District. <br /> (Signed)--------------- ----- - --- - -- ----------- -------- ----------.--:------------------------------ -------------------------- ----(Owner and/or Contractor] <br /> -- ----- <br /> sy ? - -- ----------- <br /> Piot=plan;shdwmgsiz.of o oca ion of"s ste in gelation to wells buildings;-etc. can C�plaoed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> • BY __7-=t-R,-0-------------------------- ----------------------------------------- DATE..... <br /> �--'--1-'.-��---'- ----'-(�-�-� -- =--°' <br /> REVIEWEDBY---------- -------- ------------ -- -- - --------- DATE------------------------------------ ' <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------—------"------------------------------- DATE-------------------------- ------ ------- <br /> Alterations <br /> -----Alterations and/or recommen'dations---------------------------------------------------------•--------------------------------------------------------------------------------------------------- <br /> I ei I <br /> - --- -- ----- -------- --------------a----------•-----------------------------------------------------------•-•---------• ------------------------- <br /> ------ <br /> - <br /> i rr I <br /> I ; . <br /> --------------------- ----------- ------------------ ....... - -----....---- ------------------------------------- --------------------------- - <br /> f--- <br /> 1 <br /> FINAL INSPEC Date--------- ------Z/--.—_ 5777� --------,------------ <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street x 205 West 9th Street <br /> - <br /> Stockton,California` j�odi,California s <br /> � � k .Manteca,California S @," Tracy,California <br /> F.R C a. <br /> n I <br /> n i <br />