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F OFFICE USE: <br /> i - yY � <br /> ------------------- `3c7 <br /> - ----------------------- ' <br /> '_ APPLICATION FOR SANITATION PERMIT Permit No. .y -g ' <br /> _ --- .--" (Complete in Duplicate) � <br /> - --------- �.. <br /> !V Date.issued W <br /> -__-�-- --_-•-- <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 application is made in compliance with County Ordinance No. 549. <br /> ------------------------------------------- <br /> JOBADDRESS AND LOCATION------- ----`�----- ----------------------------------------------- - <br /> 1 <br /> -------------------------------------------------------------- <br /> - - -- <br /> - :dz/-10 <br /> OwnersName------- �-----� ------------------------------------- ---------- ------- -- -------------- Phonf <br /> ' - <br /> ------------- ---------------------- <br /> -0- <br /> - ! �- �-�+ ------ Phone 6 yam. .Z-�.� <br /> Contractor's Name d---- ----------�/..=f�_.• 2---------- <br /> InstallatiN will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> r <br /> tNumber of living units: _f----- Number of bedrooms __X'-_-.. Number of baths _L_--- Lot size -_-_----__ x-- ✓---------- -• <br /> Water �$upply: Public system a' Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Chara(fter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe E' Hardpan ❑ <br /> .. _:� _ `1 10 <br /> Previous`Application Made (If yes,date----------------- ) No ®' New Construction: Yes ❑ No �' FMA/VA: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> $(No septic tank or cesspool permitted if public sewer is available within 200.feet.) f <br /> /�� lM 4-`-`-..- - <br /> SepticTank: Distance from nearest well-_l.C-t7____-;^Distance from foundation---Ld---..._--.Mater.tal------/ __ ...__ <br /> rFcompartments <br /> e__ X1 .-- ,--Liquid dp!h -----Y : tCapacity-- Q4 <br /> No. of copartments------ ----------------Siz -------- <br /> J - <br /> , - _ - - _ <br /> VA <br /> Disposal Field: Distance from nearest well__/I/n--------Distance from foundation--_/_9_----------Distance to nearest lot line--_�+'_._._._. <br /> Number of lines----------- ---'----------------Length of each line--------` a----------------Width of trench.-----2r- --------- <br /> is <br /> Type of filter material___Aa_4_��---- .-- <br /> Depth of filter material ------Total length.---____`lP----------------------- <br /> .___._S <br /> 01 <br /> �� <br /> Seepage Pit: Distance to nearest well---IYQ-----------Distance from foundation-----------__-.Distance to nearest lot line__;,t._'....--._.0 <br /> I ®s- Number of pits----.-L.____..----}--Lining material-- fpa- /c -Size: Dia mete r.= ----------Deptn___.. -S----------------------A <br /> ----- <br /> Cesspool: Distance from nearest well-..--_---------_Distance from foundation-_.----_-_?____Lining material--..-------_---_---_-------------- <br /> ------Depth----------------- - Liquid Capacity_ i_gals. <br /> ❑ Size: Diameter---------------------- --- <br /> - ---------------- -------�---- q P Y------------------ - _.. <br /> Privy: Des a Barest well________________________________________________Distance from nearest buildin <br /> g --------- <br /> Privy: <br /> ❑ Distance to nearest lot ire-------- ---------- I-----------------------------------------------------=----------------------------------------------------- <br /> d/ <br /> ------------------------- -------------- -------- <br /> " .� �. <br /> Remodeling and/or repairing {describe):------------------- -------- ` - - <br /> -------------------- <br /> I f---------f------•------------- -•----- ---'-----~ ---- <br /> ----------- - .,1 ------------------------ - --•--- <br /> -•------- -{{--- <br /> ! 1 <br /> ilzz , <br /> -- --- I -------------- - --- -------------- --_ -- - - --------- ----- -------------- --------------------------------------------- -------------------------- ----------------------------------------- <br /> I hereby certify that I have prepared thi pplication and that, the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations5of-# ewSan Joaquin Local Health District. <br /> kt_------_. ------ <br /> '..._...(Owner and/or Contractor <br /> (Signed j = <br /> -------------------------------- -- - ----------------- --- -------------------------{Title)----------}----- ------------------------- - ------ - - ----- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY I <br /> s - <br /> APPLICATION ACCEPTED BY----- ------------ ------------------------------------ DATE--- `- = ------------ <br /> REVIEWEDBY--------------------------------------- ` ------------------------- DATE----------- ---------------------------- <br /> BUILDING PERMIT ISSUED------------- --------------------------------------------------.._ -------------- _ ----------------- - <br /> DATE------------------------- ------------------------ -------- <br /> ` _ - - <br /> ' Alterations and/or recommendations:-____________ ________ ______ -.-�-.---------------------------------------�.`-� <br /> I <br /> t ----- ----------- -----------------•---------------------------------------------- <br /> --------- ----------- ------ ------ ----------r------ --------------------------------- --- ---------- ` <br /> 3 <br /> d <br /> FINAL INSPECTION BY: " ► Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT- <br /> 1601-C-Ruizolfo <br /> ISTRICT-1601-E:-Ruizolto n Ave. 300 west Oak Street 124 Sycamore Street 205 West 9th Street <br /> t Stockton,Callfornia'"�"-'^j--. -� Lodi,California Manteca,California Tracy,California <br />