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APPLICATION. FOR SANITATION PERMIT <br />P6r,,mit Noj ---- <br />(Complete in Duplicate) 42 -9 <br />Date ISSUA ---- — ------( - <br />X�ppricafion is hereby made to the San Joaquin Local Health District for -a permit to construct and install the wor herein described. <br />This application is made in compliance with County Ordinance No__�_ <br />JOB ADDRESS ON --- ---- --- -- ------ S�Z ....... - - ----- - ---- --------------- ------- ------------------------- <br />11 <br />w h�' i <br />or ore n <br />Ordinance N 'V <br />IOC T <br />Owners Name----- m% ------- - --- -- ------ ------------- Phone---- ---II ------------------------- <br />----------- <br />--- ----- --- - ---------------------------- --------------------------------- -------------- <br />Address ------------------- -- -- - -------------- ---------- <br />?__ A <br />Contractor's Name ------------------------- - �14_ X 0 ---- )hone .. ffl <br />-4 --------------------------------------- ---- Ae,7 <br />------------ - <br />Installation will serve: Residence 0 Apartment House ❑ Commercial % Trailer Court [] Motel Ll Ofh!6r El <br />Number of living units: __..---- Number of bedrooms __--_--_ Number of baths -------- Lot size---------------------- <br />Water Supply: -Public system E], 1 Community system ❑ Private 0 Depth to Water Table 6-0 ft. <br />Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam [] Clay E] Adobe Hardpan E] <br />Previous Application Made: Yes El No 471 New Construction: Yes E] No I& FHA/VA.. Yes Ej No <br />,//TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or'cesspoo.lpermitted if public sewer is available within 200 feet.) <br />Septic Tank:Distance from nearest well----__-_________ Distance from foundation___________________ Material______________.---.-__---________-------____. <br />El X, .rtW5 No. of compartments --------------------- ----Size----------------------------_---Liquid clepth -------------------------- Capacity ----------------------- <br />I I <br />Disposal Field; Distance from nearest well_______ ___________ Distance from foundation -------------------- Distance to nearest lot line--_______________ <br />❑F <br />ine----------------- <br />EIFS-rdl Number of'lines-----------------------------------Length of each line --------------------- : -------- Width of trench --------I -------------------------- <br />Type of filter material -------------------------Depth of filter material ----_---------------_-Total length --------------;I-------_------------------- 1 <br />Seepage Pit: Distance to nearest well-- Distance frpm foundation --- /40 ------ Distance to nearest lot <br />/��o ------- <br />__oxg— ---------- <br />Number of pit ------ Lining material ----- K06Ke_...Size: Diameter_____ --- Dep1h__'1'Z 71 -it <br />Cesspool: Distance from F nearest weq ----------------- Distance from foundation ------------------- Lining material ---------- III -------------------------- <br />F1Size: Diameter ------------------ -----:------------ Depth ---------------------------------------------------- Liquid Capacity ------- -------------------gals. <br />Privy- i Distance frominearesf well -------------------------------------------------- Distance from nearest building ----- - ------II-------------------------- <br />ElDistance to nearest lot line------------- - ------------------------------------------------ --------------------------------------------------------- ---- -------- <br />v <br />Remodeling and/or repairing fde ri e): ------ - Z 1.1,71.4 —.a-- 7' '1 <br />--------------------------- <br />I Aar <br />--------------------------------------------------------- L2)N/Y I --------- ---- <br />--------------- 6 <br />------------- - --- ---- -r ------------------------------------------------------------------------------------------------------------------- I -------- 11 --------------------------- <br />------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------- 11 --------------------------- <br />I hereby certify that Lhe red this application and that t"ork will be done in accordance with San Joaquin County <br />laws and rules regulation <br />ordinance's, State laws i I 7es a 7ni fZ',n of the San Joaqu/lxocal Health District. <br />laws and rL <br />(Signed) ------------ -------- ---------- - ----- ------------------ -(Owner a l/or Contractor) <br />reverse <br />sji, <br />4cen ree side). <br />By:-_--------------------- - - ------- --- ------- - --------- ---- -------- ---(Title)--- - ---- ------- - --- ------------------ - <br />(Plot plan, showing size 0. lo;;fr 4;��ystern in relation to we , buildings, etc., can be place rse sid <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED----------- - ---------------------------------------------------------- DATE ------ - ---------------- ---- <br />REVIEWEDBY ------------------------------------------------------------------------------------------------------------------------------ DATE---------------------------/'!------------------------ <br />BUI'LDING PERMIT ISSUED ------------------------------------------------------------------------------------------------------- DATE --------------------------------- I --------------- ---------- <br />Alterationsand/or recommendations: ------------------------------------- - ------------------------------------------------ I ------------------------------------------ 11 --------------------------- <br />-------------------- - -------------------------------------------------- ----- - - - --------------------------------------------------------------------------------- -_1 ------------------ ] --------------------------- <br />-------------------- --------- -------- -1 - ----------------------------------------------- 11 --------------------------- <br />-----------------------------------------------I------------------------------ --------- ----------------------------------------------- ­ ----------------------- 11 -------------- <br />---------------------------------------------------- -- ------- - -------------------------- - ------- - ----------------------------------------------------------------- ---- --------------I ---- ------------------ <br />FINAL INSPECTIO ------- ----------------- ------ Date--- ----- -- <br />---------- -------------- <br />D <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 5outh American Str^� 4 100 West Oak Street 132 Sycamore Street 814 North 'C" Street <br />Stockton, Califs—L"_VLodi, California Manteca, California _ Tracy, Californ'la <br />ES -9-2K4 <br />