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FOR OFFICE USE: <br /> - <br /> -------------------------------------------------------- <br /> — °- APPLICATION FOR SANITATION PERMIT Per No• -r � ------- <br /> - <br /> ------------------------- <br /> ------- <br /> ----- --- !_�-------- ------------- (Complete in Duplicate} <br /> Date Issued .�--"l�-` <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. <br /> This a licatiori.is.madP.Sn_.nm^1� c with County Ordinance No. 549. �31 — 3YD—� <br /> JOB ADDRESS'AND LOCATION- ------F.- S.0 -.�--- - _AW l <br /> Owner's Name- ��"w/-- � Phone <br /> Address-.-... 14----AV-....22 ? A,�__ � y� <br /> Contractor's Name-------------ee__ �,---7 7;,; 'C9-il.- -------- --------------•----------•--------------------------------•--- Phone----------------------------------- <br /> Installation willserve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> 1� 7,r} s� �'----------------- ----------- <br /> Number of living units: Z--- Number of bedrooms .e' Number of baths _A- Lot size --a // �---. . <br /> Water Supply:.: Public system ❑ Community system ❑ Private gal, Depfh to Water Table 16,-_ ft. <br /> Character of soil to a depth of 3 feet: Sand L] Gravel E] Sandy Loam Clay Loam ❑ Clay ED Adobe E] Hardpan [I <br /> Previous Application Made: {If yes,date-.------- ----------) No New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ®^ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: j <br /> (No septic tank or cesspool permitted if public sewerris available within 200 feet. <br /> 11 No. of com artments_. / Size from foundation__ --------Material a aci ------ <br /> // <br /> SeptiEc�k: Distance from nearest )�' -._ _Disfia c � J� Liquid depth---�_________________Capacity-/"', <br /> ,Disposal Field: Distance from nearest well.;�- -__Distance from foundatioq __-Distance to nearest lot line__'______. . <br /> Number of lines--�------_�_____ ________ Length of each line -�--�� Width of trenchi�.-_�___- <br /> g ld � <br /> Type of filter material_ Depth of filter material--- Total length__e�-'�-------------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------._ <br /> ❑ ; Number of pits----------------------Lining material Size; Diameter----------------- -- Depth-- ------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation____----------------Lining material--------------------._-_--_----._-_-_ <br /> ❑ I Size: Diameter----------------- -------------------Depth---------------------------------------------------Liquid Capacity- -r------------------------gals. - <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> Prlv , <br /> ❑ Distance to nearest lot line----- .-_--------------- ---------------------•---------------------- ----------------------------------------- ------------------------ <br /> Remodelin a F <br /> I g nd/or repairing (describe):----•�yb'E�_.� -_��/try �' -'-?�----•------------------------------------------------------- <br /> 67 <br /> --------------------- - ---------------------------• j <br /> k --------------- ------------------------------- ---- _..-_---____ __.______.____ .________._________.___----_-----__-__-_._______.----------__.--_.-_---__--------..---------_--_.-------------------------------------- <br /> -- <br /> _-_----------_-.---___---.--------.- <br /> __ _ /---.-___ _ _ _ •-----------------•------------------------------------------------------------•---------------------------._------ <br /> -----------------------------------------------------------------------------ff---------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby Certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and r es and regulation off the San Joaquin Local Health District. <br /> �. 1'G��/ ---- ----------------------------------------- �rd/or Contractor) <br /> {Signed}----------= --- <br /> -- --------- - -- -- -- - <br /> BY= -----------------------------•------------------------------- - -------------------{Title} --- -------------- - --- <br /> (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY(Z;*. <br /> DATE , <br /> REVIEWEDBY------------------------------------- ----------------------------------------------------------------------------• DATE------ ----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------- -------------------------------------------------------------------------- DATE------------------------ ---------------------------------- <br /> Alterationsand/or recommendations-------- -------------- - ---------------------------------•------------------------------------------------------------- ----------------- ------------------ <br /> i. <br /> ---------------- ---- --------------- ------ -- - -------------------------------------------------------------------------- - --------------------- ------------------------- --------- --------------------------------- <br /> --------- <br /> 1=1 NAL INSPECTION I <br /> ECTION BY:-_ .. Date......�_._=_�`x'__._`•-�-:7- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601,E.Hazelton Ave. 300 West Oak Street w - 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.a o. <br />