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FOR OFF;CE USE: �y 5 ..'� <br /> APPLICATION FOR"SANITATION PERMIT <br /> Permit No. ...............y_..... <br /> 3. _ __ __ (Complete in Duplicate) <br /> --- - --- • - - Date Issued __----/',:•° -b-� <br /> /L <br /> - �- � - �---- - � This Permit Ex fres 1 Year From ©ate Issued <br /> -a-E <br /> lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein delcribed. <br /> App I. <br /> This application is made in compliance with County Ordinance No. 544. <br /> N--------- <br /> 4� -------------- ---------------------------------------------- ------------ <br /> --- ---- ------- -------- --- ----- <br /> JOB ADDRESS AND LO Phone------------------- ----------- <br /> i ----- <br /> Owner s Name--------------------------- <br /> 1- - <br /> ------- 7 <br /> Address.----------•-------•-------•---• one-- --� •- , <br /> —, Ph <br /> Contractor's Name ----- '.�� -`�- -'~- �"r <br /> ---------------- <br /> Commercial [�]�railer Court ❑ Motel-❑ other ❑ <br />� Installs+ion will serve: Residence ❑ Apartment House ❑ � <br /> Number of living units: __.�umber of be _:��-."Number of baths ._."".. Lot size ....- <br /> X 9d --------- --------------- <br /> IL <br /> i 1 Private ❑ Depth to Water Table - <br /> 1 Water Supply: Public system [A Community system ❑ Adobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam•❑ Clay Loam [Clay ❑ ❑ q <br /> ' Ch FHA/VA: Yes ❑1' No B— <br /> Application Made: (If yes,date.._.- ------ No D New Construction: Yes ❑ No L� s II <br /> ' Previous App� y <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 00 feet.] ' <br /> (No septic tank or cesspool permitted if ublic sewer is available within 2 <br /> t � � � — ---anon -----------�==----.Material---- ----- ------ -------- ----I-------------- <br /> Septic <br /> -----------Septic Tank: Distance from nearest well----------------- from found Liquid depth_"------------------------Capacity_._._"i:...-"...----�- <br /> ❑ No, of compartments--" __---. <br /> Size------- c <br /> Distance from fohdationf ---------:Distance to nearest 10 � -----------• <br /> DispofField: Distance from nearest well---_.---- �� <br /> ❑ Number of lines------.._�-------- Length of each line---.°--i-;� 'i�! Width of trench--- °--- ,1_------------ <br /> -- -- -- -Total length <br /> Type of filter ma#erial_- �1� -Depth of filter material: <br /> f See age Pit: f7istanee to nearest well----- ----------Distance fr m foundation--- -- ----- ' r;�e toDepthst_4`? if <br /> - <br /> F Q� Number of pits------------/.--------Lining material_ "- ? /Size: Diameter._ <br /> Distance from'neares} well-----------------Distance from foundation_...-...---±-------Lining material.._...------------„-- <br /> Cesspool: Liquid Capacity-----------------�_...... <br /> gals. <br /> Depth q <br /> ❑ rze: Diameter - P <br /> .. --Distance from3nearest building---------------------- <br /> Privy: Distance from nearest well-----------.----------- <br /> -_---•---_'--------------- -- <br /> Distance to nearest lot line --------- -------- <br /> 0 r ------- <br /> Remodeling and/or repairing (describe):."-- _--- - --------------------------- - - --------------------------- ----------- ------ <br /> --------------------------------------------------------------- <br /> 1i <br /> .............""..__-_".. .._.."...._..II".._._ <br /> ------- -----------------------------------------------------------------------------.----......F..--... <br /> ---hereby certify that I have prepared this application andkthat.the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, a le, and regulations of the San Joaquin-Local Health District. <br /> ___.-_... wne and/or ilContracfior] <br /> ----- -------- --------- <br /> (Sighed) (Title)------ <br /> By:------------------- <br /> ._ ., ------ ----- ------ <br /> (Plot plan, showing size a 'lot, locattori of syste to relation to we11s, buildings, etc., can be placed on reverse side]. <br /> ., FOWDEPARTMENT USE ONLY <br /> , l <br /> APPLICATION ACCEPTED`BY--- --------------------- -- -------- <br /> DATE <br /> - _ DATE--- ^ t° ' <br /> REVIEWED BY----------------------------_--:-: — ---------- <br /> ---------------------------------------- <br /> REVIEWED <br /> --- ------------------------------;' <br /> �'------------- <br /> DATE---------------------------------------�-_ ----------------� <br /> -- ------- - - --- <br /> BUILDING PERMIT ISSUED---------------------------------- ---------------- <br /> a W--- -- i�a . _ __ <br /> -- <br /> Alterations and/or recommendations:'- `r--• <br /> (ap <br /> ------------------------------------- <br /> t t � <br /> t e ---- ;= —t ---��------- -- - <br /> 04 <br /> ------------------- <br /> ------------------------- --------------- ------- ------------------- <br /> o Date - <br /> �� - ----------------•-- <br /> -- � II <br /> FINAL INSPECTION BY..._- "-- ------------------ <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Haxeiton Ave. 300 West Oak Street <br /> 124 sycarnore Street los West 9th!Street <br /> Manteca,California Tracy,California <br /> Stockton,California Lodi,California <br /> e <br />