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FOR OFFICE USE: <br />--------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .l.!?e ..---------------------------------- --- (Complete in Duplicate) Date Issued ___ y <br /> /__�3_—_-_____ <br /> t Expires 1 <br /> ear <br /> m Date <br /> Application is hereby made to the San Joaquin Loctal Health Dist i t foroa permit construct 3t`lo- <br /> pP / trust and install the wo er in d-elgibred. I <br /> .This,application_is madein com&rj(t .with County,Ordinance Nd, 549. .[rP <br /> JCB ADDRESS o CATI A'` F----- --� fd 4 Com{ --- <br /> I Phone. <br /> Owner's Name._ ----- - ----F ----- ------^--=----=== w"` ........=" ---------- <br /> --- <br /> Address------------ --�-�-- --� ---- ---- - --- �- --.._..---------L,I4'?'HRO , <br /> Contractor's Name � - <br /> Installation will serve: Residence �partmen House ❑ Commercial :❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Z. <br /> g Z3- Number-of baths 4 of size __l.-(!SF-_..___7 _/_tom _�___._F____. <br /> Number of living units: __ ____ Number of bedrooms _ ---- <br /> Water Supply: Public system ❑ Community system 8 P, Nate ❑ Depth to titer Table -------- <br /> ft- <br /> gharacter of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-- -------_--------) No Now Construction: Yes lig ❑ FHA/VA: Yes P-_`N o B--- <br /> TYPE _OF_W$TALLATION AND,SPECIFICATIONS: <br /> (No septic tank or cesspool-permitted if public sewer is available within 200 feet.} I <br /> Septic Ta — Distance from nearest well_.----Distan a from foundation-_L-_E ___.__...MateriaL <br /> � . if i <br /> No. of com_p'artments____��______..____Size _ ______ squid depth____._��_._._____..Capacity_..____________. <br /> i i <br /> Disposal Field: Distance from nearest well-- .._Distance from foundation_'" _. Distance to nearest lot line___--__._____ <br /> f� _ <br /> Number of lines-- _ _.___ _ .___Leng+h of each line_ i :_____..__f Width of trench_...__._ ..--------------- <br /> r <br /> ....:.... ... <br /> Type of filter mater' _____ ___ _____Depth of filter material _ _ _...__--_.Total length____.___.______ t <br /> 1, t : �l <br /> Seepage Pit: Distance to nearest w.ell_____________ _______Distance from foundation-------------------Distance to nearest lot line_.___--:.--.___._ f 1 <br /> ❑ Number of p}ts.__.__-• -- - --Lining material-----------------------Size! Diameter-----------------------Depth----------------------------- <br /> Cesspool: Distance from nearest well---------__------Distance from foundation,._--.-.------------Lining material------___._..._..--------------------- <br /> [] Size: Diameter- --------------- --------------------Depth--------------------- ---------------------------._Liquid Capacity--------- ------------------gals <br /> Privy: Distance from nearest well----•--------. ------------------_-------- Disfance from neares+ building----- - ------------------------------------- <br /> Distanceto nearest lot line-------------------- -------------------------------- ------------•---•----- ----------------- --------------•------------------- <br /> We <br /> Remodeling and/or repairing (describe! :"--------r- -=--------- --------------`--------------------------- -- -------------------------------------- <br /> ,; ...«.. '�• - -- <br /> nw 'R t <br /> f f - ~"-- ` <br /> .r. / 2 <br /> -------------------------------- --------------------------•-- -----------------------"-------------------------------------- <br /> I hereby certify tha have`prepared1his application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, rules and regulations of an Joaquin Local Health District. # <br /> �.. }rte <br /> Sined --------------------------------------- ­ <br /> '413 <br /> -- -- {�°r <br /> (Signed) <br /> g '+ }--- .29-15 E-Miner Ave •-0 6 38,41 ^� �--- --.----- -._Title__ <br /> By: ------------------------------------------------ --- - { } - ---- -----._ ---- ----------------- <br /> (Plot <br /> -- ---- <br /> (Plot plan, showing size of lot, location of systerri`'1` lafion't0 wells,'b ildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ -_�F ---------------------------------------- DATE .......... ------------- <br /> APPLICATION <br /> BY---- ------------------- ------- - --------- ------------------ -- -­----------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Aiterationsand/or recommendations:--------''---------------------------------- ---------------------------------------------•-•-------------•-•- -------------•--•-------------- ------------• i <br /> r ---- ---------------------------------------------------------- <br /> ------------------ ---- ------ ---------i ---- ----•---------------- ----------------------- --------------------------------------------------------------------------------------- <br /> ------------------ ------- ----------- ---------- -- - ------------------- ------ ---------------------------- --------------------------------- ------------------------------------•------------ i <br /> ,�/� Date �(/.^ W ` <br /> FINAL INS Date F - 7_-_- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naselton Ave. 300 West Oak Street 124 SycamoreStreet Y 205 West 91h Street ' <br /> Stockton,California Lodi,California Manteca,California f =t-Tracy,California f+1 <br /> F.R.r Q. 1 t <br />