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uR l/rr[l,r U3r-: <br /> -�- 4� <br /> ------------------- <br /> ----------- <br /> ________________._._-..____________- APPLICATION FOR SANITATION PERMIT Permit No. 141 <br /> ------------ --- - ------ ------------------------------ (Complete in Duplicate) <br /> ----------- This Permit Expires 1 Year From Date Issued Date Issued �1 _ � <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 application is made in compliance with County Ordinance No, 549, <br /> JOB ADDRESS AND LOCATION---14 ••1 Q -----.-(1403-o5)--- ewpor-4_St_ockt n-------------------------------------------- <br /> Owner's Name----------------------------- I 4 �5 ..r '== -- -- Phone_7_1J.E2Z%40k,----- <br /> Address-----------------•-•----------------------2612-.K.--H>Wjd"g--WaY---------------a=- '\� <br /> ----------------------------- ---- --------------------------------•---........ <br /> Contractor's Name-----TIM._Day.&_.Night_-Septia.__Tatzk__S.e ------------------------------------- }--- Phone-_166-3841------------- <br /> Installation will serve: Residence [I.. •Apar•tment,House'❑"Commertial"❑""Trailer Courf"❑—Niofel'� Other ❑�' <br /> Number of living units: _-.,' - Number of bedrooms _____2' Number of bath,s ------ <br /> 2Lot size -----7511---]C1QQt---------.-- <br /> Water Supply: Public system EIMCommunity system ❑ Private ❑ Depth4o Water Table __..610ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ (CI-ay,.Loarn ❑=Clay ❑--e obey Hardpan ❑ <br /> ?J.n %. <br /> Previous Application Made: (If yes,date------.---.---------) No [lox New Construttiorl: Yes Ej No ❑ FEMA/VA Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) kt4 A <br /> • i+ f � <br /> Septic Tank: Distance from-nearest well_________________Distance fromjoundat oris( ----__ Material____._#____ __.___ _-________._ ___ ' <br /> Eci.at�.ng No. of compartments---------- ------- —• r ... _ <br /> Size---------------•--------- ._Liquid'depth--------------- ------ Capacity-••------- <br /> ------------ <br /> Disposal Field: Distance from nearest welly _-----Distance from foundation-_ <br /> oundation__�,Q__. ____._Distance to nearest lot line__8r.-_._____.d <br /> Number of lines--------1-----------------•------Length of each line-----=-�Qt_______•_-----.Width of trench----24n--------------:- ------- <br /> Type of filter material---S-ePtiC__RkDepth'of filter materiaL1__-ig�_ Total..length_:______________________�t------------ <br /> w <br /> Seepage Pit: Distance to nearest well_____NOne-------Distance from foundat-on�-_�Qt.__.'_.Distance to nearest lot line- _$ --------- � <br /> ME. Number of pits_____;------------Lining material___Rock--------.Size; Diameter ___. —1 p 25� <br /> 'T <br /> ` o <br /> I <br /> Cesspool: Distance from nearest well.______________Distance from foundations ._..Lining material____________________________'______.__ Ul <br /> ❑ Size: Diameter. Depth ------------ ' ---------= ---Liquid Capacity---------------------- ---gads. <br /> Privy: Distance from nearest well-------____------------------------------___.__-Dicta .Ge: from nearest building----------.______._____._ <br /> ❑ Distance to nearest lot line--------------------------------------- <br /> -----------_-— -- p <br /> ---------------------- ------------------------------------------ C <br /> G <br /> Remodeling and/or repairing (describe)= ------ --•-- ---------------'--------•------ --------------- -- <br /> SUPPTEMENTARY--llRAINAGEs-------Exfstjn d3 plex l__hecirQom_each_» <br /> } --- <br /> -------------------------------------------------__--------------------------------------_--------------------------------------------------------------------_------------------------------------------------- <br /> ..-_______._._ i <br /> 1 hereby certify that I have prepared this application and }hat'the work will'be done it accordant withSan Joaquin County <br /> ordinances, State lawsyaand rules and regulations of the San Joaquin Local H th District. <br /> (Signed)..---------- <br /> - AV --------------------- ------- --------- -- ------ (Owner and/or Contractor) <br /> B'sE c---'A is sEr�NIFICIE------------------------- --------- - --- ------------------- -- - ------- --(Title) <br /> (Plot plar??i§&1W0eAz*e4 lo1{doEd"" of system in relation o wells, buildings etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ------- ---- DATE /ta.�'���. <br /> REVIEWEDBY------ ------------�----------- ------- - --�------------ ---------------- - --------------- ----------- - --------- DATE---------- --------------------- ------------------------- <br /> BUiLDING PERMIT ISSUED •— ----------------------------------- DATE-------------------------------------- ------------------- - <br /> Alterations and/or recommendations:----------------- ---------------------------- <br /> -------------I--- <br /> ------------------------------------------- ------------------------- -------- ---------------------- -------------------------------------------------- ---------------------- = -----------.-------------- <br /> ------------------------------------------------------------------------- <br /> --------------------------- ---------------------- <br /> -------------------- ------------------- •----------------- ----- '1 <br /> ------------------- --------------------- <br /> I <br /> �i <br /> FINAL INSPECTION BY:- - --- - �- ---�--`� ---------------------------- Date-------------------- <br /> SAN <br /> -- - - - --------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca, California Tracy,Califurnia <br /> f <br />