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FOR-OFFrCE USE: i . <br /> --------------- ----------------------------- <br />- ------------------------------ W APPLICATION FOR SANITATION PERMIT Permit No. � = <br /> ------ -------------------- <br /> (Complete in Duplicate) <br /> ----------------------- <br /> ---------------- This Permit Expires I Year From Date Issued Date Issued <br /> Application 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. 549. A4T-C-A <br /> ; F_�:C. .2 <br /> JOB ADDR SSANDL1q0CeA__ -------------- <br /> TLON--t....... - --------I------------/+---_-Pt---------------I--------------- 5-- ------------ <br /> L <br /> --- ------ <br /> Owner's Name------- -----S.. -- -----R- ...jj---- ---- ------ Phone------------------------------------ <br /> Address----------.I. ........­q.V_1.&7A__1---- ----------------M, <br /> Contractor's Name---------e_W__1VZ1Z!-------------------------------------- <br /> ----------- ---------------------------------------- ------------ Phone---------------------------------- <br /> Installation will serve: E Resident6 23-'-Apartment House E] Commerciarl i E] Trailer Court ❑ Motel [-] Other E] <br /> Number of living units-. j----- Number of bedrooms 3-Number of 9d' ths j... Cot. size -------19_!��- ------I----------------------- <br /> _�_ I \ .t t T <br /> Water Supply: Public system El Community system 0 Private R4--Depth to Water Table __ ft. <br /> Character of soil to a 'd6pth of 3 feet: Sand Er! Gravel E] Sandy Loam [-] Clay Loam E3 ',Clay E] Adobe [I Hardpan C] <br /> Previous Application Made:_(If yes",d a_te:#a'l -------) NooEj` New Construction: Yes-44�0 E] FHA/VA: Yes E-] No <br /> TYPE OF INSTALLATION AND SPtCfFICATIONS: <br /> (No septic tank or cesspool permiffbd if public sewer is available within.200 feftf.) <br /> Septic nk: Distance + ll <br /> fm-nearest-we ___3�2-----Distance from foun'da1ion__.__/e <br /> ff I., I - _.____.Material.----C M1 . <-R- <br /> j- "V; <br /> - of compartments______ 4/k'JP.A_57__Liqu-id depth_____ —-----Capacity-,/ <br /> No ----—-------------Size---?r <br /> Disposal Field: 1 Distance from nea=rest weii_._54 ----Distance from f6unclat, -------Disfs-Ance to nearest lot line _4.________ <br /> T ;;4r�t.q----Length of e Iiin <br /> Number of h6es_t each 3?:7V__6 ftk-01 trench------136-!_ <br /> RO C, -------- <br /> - - k�� — <br /> Type of filter maferial--- --Depth of filter r�iaferial------ ___,____Total length_______.._.-, <br /> Seepa-e-Pit: t4 Distance to nearest well----------------------Distance from'�f8undaftion-------�-t-__�_.___Distance to nearest lot lif <br /> . 9 - %A <br /> F] Number of pits----------------------Lining material-----------—_ <br /> ... .....Size.:,Diameter----------- ------- ----Depf h----------------------TI&O <br /> Cesspool- Distance from nearest well__h',----------Distance from foundation___________________ Lining material____.__..,_._____-.__.______,___,._ <br /> ❑ Size: Diameter---l----------------------------------DeI I <br /> pth-_------ ----------------------------------------Liquid Capacity-...---------------------.--gals. <br /> Privy: Distance from nearest well-----------------------------------------------'Distance from nearest building_______._.__________________--___:_`- <br /> ❑ Distance <br /> uilding-------------------------------------- -'Distance to nearest line------------------_ <br /> 1P ----------------------i------------------•--•-------------------- ------- ----------------------------------------------- <br /> Remodelingand/or repairing {describe)------------------------------------------------------------•----------------• -------------------------------------------------------------------- <br /> ..........------------­_­­--------------------------------I-------------------- ------------I------------------------------------------------------------------------------------------------------------- <br /> --------------------- I I--------------------- i I <br /> ------------------------- -------------------------------- ---------w------------------------------------------------------------------------------------------- <br /> -t --------------------------------------------------------------------------------------------------------------------------------------------- ---- <br /> I hereby certify that I have prepi <br /> ared this application and that the work will be done'in accordance with San Joaquin County <br /> ordinances, State laws, and rules and gned regul'atio�qs�_c�tthe,San.Jeaquin Local.Health,District. <br /> Si <br /> ( <br /> .. . ... - ------- ------------------------------------------------------------------_(Owner and/or Contractor) <br /> r.By:--------------------- ------ - -------------------- ---------------------------------P--------------i-----(Tif le)---------:--------------------- --------------------------------- <br /> -— ---------------------^_ - , <br /> (Plot plan, showing size of 18-tTl6cation 0 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ -------------------------------- ---------------­_+�--------------------- DATE--------- —-------------- <br /> REVIEWEDBY-------------------------------- .......... ------ ----------------------- -------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING-PERMIT-ISSUED_—_-_—_ _.1-___- —----- <br /> Alterati�r�s and/or recommendations-....-5--:!/C- ------ <br /> - --------------- <br /> .........G.00-OT10NJ-----7P-------F_R-16.-N.77. Z?� L)-- ------------0,K_ ------------- <br /> ----------------------------------------------------------------------------------------- ------ ---------------------------------------- <br /> ---------------------------- ------------------------------------------------------ <br /> -----------------I-------------------- -- -- ---------- ---- --- - ----------- ------ ---------------------- --------------------------------------------------------------------------- ------------------------------- <br /> ------------------------------ ------­­ ..... . ----------------------------------------------------------------------------------- ---FINAL INSPECTION - -------- --- - <br /> Pao Date----------1�_ ...... _S ----------------------- <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 /> ES 9 REVkSED B-59 3m 3-63 F,P-iza, <br />