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APPLICATION FOR SANITATION PERMIT �,� Permit No. _--y �� <br /> {Complete i QuplicafeJ . �_ --------- <br /> Application is hereby made to the San�Joa r S' .�zv Date Issued _r-- ,,'J� <br /> q Local Health District for a permit to construct and install the work he described. <br /> This application is made in compliance with County.Ordinance No. 549. <br /> JOB ADDRESS•AND LOCATIO riyo, YL /,1, 7 <br /> Owner's Name 1 - 1 w.oevrUG(-- <br /> _Vis. n. <br /> ----- - <br /> Address. ----•--•------------ r . �. -------------- Phone., <br /> -------- 0 , <br /> Contractor's Name-----�_ <br /> F - --------- - /--o—�c' wY <br /> ---- Phon <br /> Installation will serve: Residence Apartment Hfouse ❑ Commercial E `Trailer Court j] Motel Other � <br /> - <br /> Nurnber -- <br /> of living units: _ Number of bedrooms - -_ Number o-baths _-� Lot size _ <br /> Water Supply: Public' s sterni' -` _'��� <br /> Y Commuriit system Y Y ❑ Pri4ate Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Q Gravel ❑ Sandy Loam. <br /> Previous Application Made: Yes t LId! -lay Loam ❑ Clay ❑ Adobardpan [] <br /> ❑ No New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS- <br /> (No <br /> ❑ FHA/VA: Yes ❑ No ❑ <br /> (No septic tank or'cesspool permitted if public sewer is availableithin 200 feet.) { <br /> .... ; <br /> Septic Tank: Distance from nearest wall1_Q _r. �pistance from"foundation--- _- �_: ". e , <br /> No, of compartments ----- Mate ial--_- .__--- <br /> ------------------Sze- - <br /> � Liquid depth-- 07 <br /> - r` <br /> Disposal Field; Distance from nearest welll ___ __ �r` -- RAO./ <br /> D+"stan�e from foundation-_-�_.O <br /> Number of lines-_--__ .-- F ----------Distance to nearest lot Iine_/Q•'- „ <br /> -------------------�.Length.of each line------ _ <br /> Type of filter material p r •-----.Width of trench <br /> *�^ _.I De th of filter material---J� '_--,--.Total length------ f• (� <br /> � � - I <br /> Seepage Pit: Distance to nearest well `-:_f____TDistance from foundation'-__ ..........•.'pistance to nearest lot line--- <br /> Depth ---------------- <br /> ------ �s I <br /> El <br /> p Distance from nearest well-- +ng aterial- -°'_ .o -__-._ .Size; Diameter---------------- <br /> Cess ---------- <br /> Cesspool: ''umber of g a Lin <br /> ----_Drstance,from foundat+on-------------------Lining material----------------- <br /> Size: f�iame#er--------- Depth: -. _-'�------,—_.. �- <br /> . Liquid Capacity---------•---------------•--gals. , <br /> Privy: � Distance from nearest well_--_;_______-__--T"".�-_#---- --------- <br /> ❑ +�- Distance to nearest lot line_--��__ ._----_-__ Distance from neares# building--____-,--_--__ <br /> --- <br /> Remodeling anc/' or repairing (describe: IF <br /> - ____ <br /> ------------------------------------------------_ - -- - ---- --- - -- <br /> i. <br /> --------------------------------- -----------•_-____--•--•_-___--•-_-------- ------ -----_•----------------_--___-_•---y--- <br /> --_---- _ 1---- ` k w <br /> q ---------------------•----•----------------------- <br /> I hereby c rtify that.I have prep d this application that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta a fa s, and rule and t ulations' of the S n oa ui Loca ealth District. <br /> (Signed)-----------•- --- - -- - -- - -- - <br /> ----------- --- <br /> - --- ---- --- <br /> BY: ----------- ------•- - i an rac <br /> E ---------{Title) <br /> t tort <br /> {Plot plan, showing size of Io}, location of system in relatiap 'o'wels, buildings; c., can be aced on reverse side). <br /> ' s FOR DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED BY_'- <br /> ------ DATE-V <br /> REVIEWED BY - ----- --------- DATE.JYP'. ---- <br /> BUILDING PERMIT ISSUED <br /> ---------------- --------- DATE-----_VAi <br /> Alterations and/or recommend ations:---f------------------' __--------_ <br /> 4 ----------------------------•-------------•----•---•---•---•------•---------------•------'------- <br /> r <br /> ,. <br /> ., -•--- r <br /> ----------------------------------------------------- <br /> ---•------- ----------------------- ----- <br /> r <br /> --------------------------------- ---------I--------------------- ------------- <br /> ------------------- <br /> 3 FINAL <br /> -------------------------------- <br /> FINAL INSPECTION BY:--' i .-. _-- -- - �------- - ate-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street132 Sr <br /> ycamore 814 North "C" Street <br /> Street <br /> Stockton, Celifornie Lodi, California Manteca, California <br /> Tracy, California 1 <br /> -9-2M , <br /> Revised 1.57 F.P.CO. <br /> r <br />