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rvK urritrt u5t: ti _ -- - T <br /> --------------------- ------------------- --- . G <br /> . _-.__._. APPLfCATION FOR SANITATION PERMIT Permit No.�d_.d�j - <br /> - - --_. ------- (Complete in Duplice+e) <br /> a�g"�N - •Z-azccSE q�F ► This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to con fri ct and • all the work herein described. <br /> This application is ma in compliarice with County Ordinance No. 549.' '2 ~�DM*Mti <br /> ' JOB ADDRESS AND OCATION•_____/D-c1_l!.s�" "" V <br /> c <br /> Owner's Name---------- �--(�-(�" �• <br /> ---------- ' Phone .'_ '_rG,C, . <br /> Address +jF �-•---------- --` <br /> / ----------------------• ------- ) <br /> Contractor's Name-AAj?R/r_. Ire ____ # <br /> 1 ------- - Phone.. - <br /> - -------------------------------------------------- <br /> Installation will serve: Residence [Apartment House El Commercial E] Trailer Court ❑ Motel 0 ElOther <br /> Number of living units: __l__ Number of bedrooms r� <br /> •: r ...7.. Number of baths Lot Lot �ze ___�,j7?_1{__f O 0- _ <br /> --------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Ta(le ._ ft. <br /> Character of soil to a d pt o{`31feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-'_"_'`•. -...---} No � New Construction: Yes to E] FHA/VA: Yes F] No� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> - , <br /> (No septic tank or cesspool permitted if publicsewer is available wi+hin 200-ftt:) <br />- _ _ , <br /> Septic Tank: Distance from nearest well_--; _ Distance from foundation-- <br /> 4. <br /> No. of compartments......._ _____--�S-ize---—X1O Liquid de th_.._ Ca acit <br /> Dis osal Field: Distance from nearest well---�0-.--_D stance f dation p Y { <br /> I --------------- <br /> ---� 1-- .:Distance to nearest lot liner_.____---._- (l� <br /> Number of Ines-,------- .--, --------Length of 'eac�hWi 0 --- ----- -- r <br /> _.W,dth of trench.----- �____- <br /> L 1, <br /> Type of filter material,-- 0C -__ p p. l - <br /> p g - ; 1'S _---De th o filter material_-�- - ------Total length-._-- <br /> See a e Pit: Distance to near well.___..__ ___ Distance from foundation-----------------.-.Distance to nearest lot line-------TR4i <br /> ❑ Number of prts--- ----------------•--Lining material---_- -------- -_-Size: Diameter-I---- - 'c <br /> 4*0' M D ptn. 'f <br /> Cesspool: Disfance from nearest well-----------------Distance from foundation._- aLin ni g material_-._._- G I <br /> ❑ ize�tD meter - ----- -------------.Depth--------- -- ----- Liquid Capacity gats. <br /> ------ ----- -- <br /> ------------------------ <br /> Priv C­ <br /> ------------------------------------ �. <br /> ❑ Distance to.neare rest Weil D.istance f%m aresf building_ _________________-____ <br /> Y isfance from ne t <br /> i . -----st lot line_-_.___ p <br /> l <br /> ----------------------------- --------I- <br /> ------ ------- --- ------ -------------------- <br /> -- <br /> --------- - ---- ----- - <br /> Remodeling and./or repairing (descriE�e)___________ <br /> .,.. I ---- --------- <br /> = ----•---------- - - - - <br /> --------------------------------------- <br /> 4_._. <br /> --------- - <br /> ------------------------------------- ----- <br /> ---------------------- -------------------------------------- --------------- ------ <br /> I hereby certify .that I have prepared this application and,Qthat.t:he rwork-will be,done in accordance with San Joaquin County <br /> ordinances,, S laws;:and rules andregulation's' of`+fie San Joaquin Local'Health:District. <br /> (Signed)___ _- f': <br /> t� ;-----------------•------- ------ -- ------(Owner and/or Contractor) <br /> BY:------------------------ = <br /> ---------------------------------------(Title) r <br /> ------------------------- <br /> (Pl <br /> ot plan, showing size.of lot, Iota+loci of s stem in relation to wells,,buildings, etc.,_can be placed on reverse side). <br /> t ( FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.__ ; ............-- - J <br /> -- ------------------- DATE----- ": ��. -- - F <br /> V EWED BY _--------- ------ ------------ <br /> ---- ---- - - -- <br /> -- ------------- DATE------------------- - <br /> BUILDING PERMIT ISSUED.-_ ---- <br /> ---------------------------------------- - - <br /> ------__.----------------------------------- DATE---------------------------- - - <br /> - <br /> Cera#ions and/or recommendations:--__-_#____________________------------ -------------------------------------------- <br /> --- - <br /> 1 -------- - <br /> --------------------------------------- <br /> -- ---------- -------- I <br /> - ------------------•------------------ <br /> ------------------------- f _. . ----•----- <br /> ----- - --- <br /> --- 4._ - ----- <br /> FINAL INSPECTI --- -------- 4 1` 'Date------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street ' <br /> Stockton,California, Lodi, California Manteca,California <br /> /7��J�' <br /> �., � Tracy,California <br />