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IUK OFFICE USE'; ' <br /> 4� <br /> ----- -------------------------------- <br /> -------------------------- <br /> -------------------------- --- -- -- -- -------------- APPLICATION FOR SANITATION PERMIT Permit No. .......... <br /> ----------- --------- --------------------------- (Complete in Duplicate) �. ' <br /> Date issued �. -�i <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.This applicatiojl is made in compliance with County Ordinance No, 549. <br /> JOB ADDRrSS AND LOCA I L <br /> ----7--- iQ 'G ----------------- Q� AVX_ <br /> Owner's Name-------------=------- ---------- <br /> -ZF iVOR - ----------- ---------- ----------- Phone--------- <br /> Address--- __1-, -_ �`� -- �' C�Xp ---------- T <br /> Contractor's Name---------t0_rtV[v- <br /> t ---------------•----------------------- --------------. Phone..----...... <br /> Installation will serve: Residence [Ej/Apartment House ❑ Commercial ❑ Trainer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ -._ Number of bedrooms -ZNumber' of baths ----t--- Lot size ------ / _ J SJR I�-------------------- <br /> Water Supply:Supply: Public system ❑ Community system ❑ Private T—'5e_pth to Water Table _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ k <br /> Previous Application Made: (If yes,date--------------------) .No (-New Construction: Yes 9--No ❑ FHA/VA: Yes ❑ No�—.� <br /> _ . .T-YPE-.OF INSTALLATION AND SPECIFICATIONS:* <br /> S !-�t �-fit+' i.9 •....-�.��._ .�-_.;....i-...—�,.,r �. _. - - � � s <br /> (No septic tank or cesspool pev rmitted if,public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--------- ___1Distance from foundation--._h -- ateriaf---_ CARR-Lr`L'> W <br /> ❑' No. of coni artm40�ents_ _-_-----Size- _ - (-._ _•_Liquid depth_ .-__.-___Capacc#y-., ( _______ <br /> P ------�---- <br /> Dispo❑sal Field: <br /> Distance <br /> from earest well- _Q---__Distance from foundation-----/0-___-.-.Distance to nearest lot line-.-�._---_. t <br /> • <br /> .r.,..-'*4w /---- ----- �'-------Length of each line---��----------------Width of trench- "3&-K . A <br /> Type. of filter material _ 1_C _ Depth of filter material------/-7-- `---_Total length-___------*� ___-__f <br /> "'ar, -------- <br /> Seepage Pit: Distance to nearest well ----- 011stance=from foundation_----------------------_- <br /> - Distance�to.nearest lot linei.------- �, <br /> El Number f pits - Lining mater I -size',Diameter ---------- - ---Depth._A---------------------------- <br /> Cesspool: - j <br /> Dstance f om\n`earest well-----------------Distance from foundation-------------------- <br /> Lining material <br /> El Size. Diameter Depth <br /> --...Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest,well---------------- ------------------. - .-.-.Distance from nearesf building <br /> ❑ Distance to nearest lot.aine------ - ------------------ i <br /> Remodel i.ng"and/or repairing (describe):-_-- -.- <br /> ---------------------------------•--------------------------------------•--------------------------- ----_. <br /> ---•------•-- <br /> ------------ ------------------------------. I-------------------- <br /> -------------------- --------------------•----- <br /> _. - t t i, ! <br /> W----------------------------------------------------------------`'-------------------------•---------------------------------------- It <br /> I hereby certify tlraf I have prepared'thii:appli' ation and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,4and rules and r ulations of the San Joaquin Local Health District. <br /> (Signed) X-- • �C - ------ ------------------------------- � . <br /> � _ �.. ----------- -----(Owner and/or Contractor) `.� <br /> -_r <br /> - -------------------------------------- -------------------- -------------- ----------{Title)-------------- - �----------- ------- --- <br /> (Plot pl7n, showing sizeof lot, location of system in relation to wells, buildings, etc., can be:'placed on reverse side). <br /> i <br /> 001- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- ------- -------------- ----- <br /> REVIEWED BY----5d__4`'-- DATE �Z -`L-_.�- ---�----------- <br /> DATE------------ <br /> BUILDING PERMIT ISSUED:__ DATE <br /> Alterations and/oh`recornnendations:--------- -------------- - <br /> ------- -----•----------- <br /> --------------- = ---- I------------------------- <br /> ------------------------------T_1­4_1----- <br /> ------------------------- ---- <br /> ----- -- ---- -- ---------- - <br /> -------------------------------------------------------- --------------------- <br /> �.a <br /> ' -__-F-- --- -------- _----.-_-__-..-_------------- .-..---- <br /> FINAL INSPEC � <br /> ---- Date- <br /> SAN JOA U t i `�,,•�«•k�.�:� � ------- � �--- -- ------ -------- - <br /> ------------- <br /> Q IN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave, f <br /> 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.Co. <br /> E <br />