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l"UROFF4CE USE: <br /> ----------- ------------------------------------------ <br /> ---------- ................................ ........ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------- ------- ----------- (Complete in Duplicate) <br /> .......... - ---------- .....I--------------- This Permit Expires I Year From Date Issued Date Issued --- <br /> Application ---------- <br /> is hereby made to the San Joaquin Loca! Healfh District for a permit to construct and install the-work herein described. <br /> L This application is made in compliance with County Ordinance No. S49. <br /> - -JOB ADDRESS ANTU'LOCATION 4�3 EA57- <br /> 44�7N_Ra <br /> .--T------- <br /> Owner's Name--------------- W& ---------RD------(-1-1 —------- ----------------------------------------- <br /> Address_--------------7-PT Phone------------------------------------ <br /> ----------------------------Mlmtq,---------------------------- <br /> Contractor's <br /> ----------------------------Contractor's Name__R_M__ji------ 7- <br /> —---------------------------------------------------------------- Phone <br /> Installation will serve: Residence tr—Apartment House ❑ Commercial [] Trailer Court <br /> V 0 Motel 0 Other ❑ <br /> Number of living units: Number of bedrooms 3__ Number of baths - _�Lot size ---- 4C <br /> Water Supply. Public system F Community ---------------- <br /> I y system E] Private Depth to Water Table /-5--ft. <br /> Character of soil to a depth of 3 feet: Sand 2t'rave) E] Sandy Loam E] Clay Loam C] Clay E] Adobe [I Hardpan <br /> ❑ <br /> Previous Application Made. (If ye;'date_..___.- _-_----_) No Vj_ 'New Construction: Yes ET--Iqo El FHA/VA: Yes-®--No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .-.;.(No-septictank-or-cesspoof permiffed.,if public sewerjs ayailable.Lwif hin 2Qk�fe�qtj <br /> Septic T nk: Distance from nearest well-----SO...Disfaqcp from fou�clat;on----/10-------- Maf6rial <br /> No, of compartments__-_2------------- ---Size--;KI"/L9----lr� Liquid depth___- Capacity_/;?�-.&, <br /> R ------------ <br /> D;sposal..eld: Distance from nearest well.._5__0-_.-.Distance fromt foundation--- <br /> Number of lines___.____-_- --- -.Distance to nearest lot line---- <br /> Type of filter - -----Length of each line----/Jr- ----Width of french------ _r---------------- <br /> -.------Depth of filter material-I----i __TotaI length---------- <br /> ----------------------- <br /> Seepage Pit: Distance to nearest well______________ <br /> ________Disfance�from foundation--------------------Distance to nearest lot line <br /> El Number of pits---------------------Lining material-------------- --------Size: Diameter---------- ------------Depth------- --------------------- <br /> --- U'3 <br /> Cesspool: Distance from nearest well__________-------Distance from foundation----------- -- -- Liding material__--__--______--.-._----- 10 <br /> F❑-1 1 ----------- rN <br /> Size: D�arnefer------------------------------------- Depth-.--- ------------=------------------ <br /> -- -----------Liquid Capacity---------------- ---------gals. ,Ij <br /> Privy: Distance from nearest well--___---_---------------------------------------Distance from nearest building-------------------------------------__--. <br /> ❑ Distance to nearest lot fire <br /> Remodeling and/or repairing (describe):---_--------------- <br /> --------------------------------------------- - (describe):--- ---- ----------- ------------------------ <br /> - ------------------------- <br /> ----------------------------- ------------ <br /> ------------------- <br /> ------I------------------------------------------- -------------------------------------------------------------- - <br /> ----------------------------------------­------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------% <br /> - ---------------------------------------------------------I------------------:--------------------------------------------------------------------------------- ------ ------ - ------ <br /> ------------ --- ----- ------ - --- <br /> I herebVerify that I have repared this application and that the work will be done in accordance--w-ifh--San-'Joaquin County <br /> e "",3're <br /> ordinanc S, f I s, and rule andulafjons of the San Joaquin Local Health District. <br /> (Signed)- ------ -------- <br /> ------------ -------------------------------------- -----------------------(Owner and/or Contractor) <br /> �"bc d <br /> By:----------------------------------------------------------------------------- --------------- <br /> -------------------------------- -----(Title)------------------- -------- ------------ ------- --------- <br /> (Pldtr'pig-n--.-th-dwiii-q-rsize-o-f-l6t7 0-cation of system-ii-relation-fo wells,--buildings,-efc;-, cam-6e-placed-on--reverse-sidef). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- <br /> --- - --------------- DATE------ <br /> REVIEWED BY------------- - -- ----------------------------- <br /> ------- ----------------------------------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED-'—------------ f <br /> ---------- DATE <br /> ----------------------------------------------------------- <br /> Alterationsand/or recommendations:____________________----------------------------------I -----------------------I---------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> -------------- ----------------------------------------------------------------------------------- ----------------------------------------------------------- -------------------- ------------ <br /> ------•--------- ---------------­1------------------------- ---------------- ----------- <br /> --- ------------- --------------- ------------------ -------------I----------------------------- -------------------------- <br /> ----------------- ---------- - --- - ------ ------- ..... <br /> ---- ---- -------- --------- ---------- ------------------------ ------ - -------------------------- -------------- <br /> FINAL INSPECTIO <br /> .. . . .. . - --- ----- - Date------ --------- <br /> -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br />