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FOR OFFICE USE: <br />------------------- -- ----- ----------- -------- <br /> ' <br /> -- -------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. <br />----------------- ------------------------------------- (Complete in Duplicate) Date Issued <br />------ -------------------=-------------------------------- This Permit Expirel 1 Year From Date Issued <br /> ApplicatiA is-_heeby made to the San Joaquin Local Health District for a permit to construct �rstall the work herein described. <br /> This application is made'in compliance with County Ordinance No. 549!' 6 ;7 <br /> Ui x 0 <br /> JOB ADDRESS AND LOC TION_7(�51 P-.6—= -- --------- ----- <br /> --Y�_F------- ------------------------ <br /> Owner's Name----------------- - L --------------------------------- Phone----------------------I......... <br /> Address-----------------J5-_3�9.......... --------:_A_V-- ------------------- ------------------------ --------- ----------------- <br /> �­Confracfor's Name-----Wont>Y6------ ------------------------------L------- 1----------- Phone--------------------_--- <br /> 7--- <br /> Installation will serve: Residence E,"Aparfment House Commercial E] Trailer Court <br /> Motel Other ❑ <br /> Number of living units: _/---- Number of bedroom's Number o 'athsa__ Lot size <br /> ---- ---------- <br /> Water Supply: Public system [] Community system [:1 Private �Drth to Water Table�5_ ft. <br /> Character of soil to a depth of 3 fee+-. Sand E] Gravel Ej, Sandy Loam ,��_ Clay Loam E] 'Clay 0 Adobe F] Hardpan F] <br /> I q <br /> Previous Application Made: (If yes,date-------- ..........I No �r New Construction: '.Yeloll"�'No 0 FHA/VA: Yes El <br /> No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool per;ni+fed if: public sewer is available within 200 feet.) <br /> Se nk: Distance from nearest weil--5 ------Distance from foundation--_ --------- ial....CQ.NKA_F��---------- <br /> .Mater <br /> No of compartments____--..-_ :...Size.,5--_A C- <br /> ....._/--------------Liqu;d depth-_._ ---Capacity-.�sw <br /> ---------------- <br /> Disposal Id: Distance from nearest. .v:..:-Distance from foundation-----/0....._. istance to nearest lot line--_--5---—___ <br /> Number of lines---- ------!�------I---------------Length of each line-------665----------------Width of trench.------ ------ <br /> rc <br /> Type of filter material---R_0_CK,___Depfh of filter material____--�_c7-----------Total length---------------------- <br /> I <br /> Seepage Pit: Distance to nearest well----------------------Distance from' foundation--__.--..--_.._----Distance to nearest lot line-------------- <br /> ❑ Number of pits----- ----------------Lining material.......................Size: D;amefer.-.---------------------Dept h__------ ------------ ------- <br /> Cesspool: Distance from'nearest well-----------------Distance from foundation -------------------Lining material____-__-_------_-.----.---- ----. <br /> ❑ <br /> naterial--_-------------------------- ----- <br /> F-1 Size: Diameter--- 1----- ------------•- ---..._...Depth------------------------------ ---------------------Liquid Capacity-------- -------------------gals. <br /> Privy: Distance from rea!esf well----------------------------------- ------------ Distance from nearest building.-..-..--------_-_---.-----_-----._-- -. <br /> ❑ <br /> uilding------------------------------------------ <br /> El Distance to ned!78500t lire---------------------- ------------- ----------------------------------------- -------------------------------- ------------- <br /> Remodeling and/or repairing (describe):---------__..............•-----------------------------­­---------------------------------•---------------------------------------------- <br /> --­--------------------------- ------------------ ----------------------------------------------------------------------------- ------------------------------------- ----------- <br /> ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------I---------------------------- ----------------- <br /> ------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- ---------------------- <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 rules and 'regulations of the San Joaquin Local Health District. <br /> ig!ed)-- - ------------- ----- - - ---- --- - <br /> - - - - (Owner and <br /> /or C-ontractor)- - - <br /> By:---------------- ------------------------------6-----------------------------------------------------------------------------(Title)------ --- -- - ---------------- --------- -- ------ --------- <br /> (Plot <br /> 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 <br /> APPLICATION ACCEPTED BY--------- ------------------------- ------------------------------------------ DATE--------- ,57------------ <br /> REVIEWEDBY---------------------------- ------------------------------------------------------------------------------------DATE------------------------------ <br /> BUILDING PERMIT ISSUED-------------------- ---------------------------------------------------------=---- ---------------- DATE <br /> Alterations and/or recommenciations:--'I'!-IVOTA7rtON�S------O-Al- _M790 --------------:°---------- <br /> t <br /> -------------------- <br /> ------------------------- <br /> --------------------­ ------------------------ ----- - - ------------------- <br /> --------------- -------------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------------- <br /> -----------------= --------------------------------- ------ -- ---- ------------------ -------------- ----------------------------------------------------------------------I----------- <br /> ................. ------ --------- - -- - ------- ------ ------------------- ... ... - - -------------- ------------------------------------------------------------------------------------------- <br /> FINAL,flNSP 'Date. - - ---- <br /> 4-7--------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hc ixelton Ave. <br /> 300 West Ciak.Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi',CaliforniaCaliforniaManteca,California Tracy,California <br /> F.P:6 <br /> 4 <br /> 1W, ✓ <br />