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FOR OFFICE USE: •. <br /> --------- <br /> ------------------ - APPLICATION FOR SANITATION PERMIT Permit No. e413422- <br /> ----------------------------- <br /> .41312.._..----------------------------- ---------------- ------ (Complete in Duplicate) <br /> --- ------- -- --- - -------- - -- ------------------ This Permit Expires 1 Year From Date Issued Date Issued <br /> 224—o L-ic a Z-`/ <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 lication is made in compliance with County Ordinance No. 549. r� <br /> ,223 S_ v�� IV <br /> JOB ADDRESS AND LOCATION CRK-------- -- EF}N.�_FR-----`4---- K l L } <br /> ,�� -6 E T------------ �_-C.K-5- ------------ <br /> Owner's Name----------------- f ------------ ---- --------- -- -------- Phone------------------------------------ �4 <br /> Address _ ... 71 .E 1_T— ------------ .T C = <br /> -- <br /> 'f <br /> Contractor's Name--------...- aL A.ez --------------------------------------------------------------------------------------------- ------ Phone------ -----•---•---•-y-------------. <br /> Installation will serve: Residence Fj­Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units. ...._.. Number of bedrooms .3- Number of baths _2_ Lot size ...-�:�_ �D� Q---.----4-__-------- <br /> Water Supply: Public system ❑ Community system ❑ Private 2 �D_epth to Water Table I_ ft. <br /> Character of soil to a depth of 3 feet: Sand (Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No e New Construction: Yes �o ❑ FHA/VA: Yes [� No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----5--.-.Distance from foundation_..IQ.. - .Material....eC3 <br /> .-.-% -----Capacity---- <br /> No. of compartments- --- ------ Size.. _X�.Q.- k 5_ Liquid depth <br /> Disposal �00--- <br /> F4 <br /> Field: Distance from nearest well.- ______Distance from foundation.f-0....____ Distance to nearest lot lin e_-ate.........- { <br /> Number of lines-...__.-1 ------3_...._-__Length of each line-211 -719- Width of trench.-.-r���---- ----------------- <br /> Type of filter material__ -. .0Cj4-----Depth of filter material.... ______-Total length-------152---------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_..--------------------Dept h---------------------.---------_- <br /> Cesspool: Distance from nearest-well-----------------Distance from foundation__________-------_Lining material..._- ..-.-------..._...-.___._. <br /> ❑ Size: Diameter----- - ----Depth-----------------------------------------------------Liquid Capacity-------------- --- -----gals. <br /> Privy: Distance from nearest well._----------------------------------------------Distance from nearest building------- ----------------------------------- <br /> ❑ Distance to nearest lot hne - ; <br /> Remodeling and/or repairing (describe):----- ------------------------------------------------------------------------------------------------------------------------------------•------------- � <br /> --------------•----------------------------------------------------------------------------------------------------------------------------------------------- -------- - �f <br /> ---------------------------------------------------------------I--------------------------------------------------------------------------------•-•-------------------------- ----------------------------------------------- \ <br /> ----------------------- ------- -----------------•------•-----------------------------•----------------------------------------------------------------- -------------------------------------- ------- - - ---------- <br /> I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County k <br /> ordinances, SfaiA laws, and I nd regulations of the San Joaquin Local Health District. lt, ' <br /> a - � <br /> (Signed)--- -------------------- ----------------------------------------------------------------(Owner and/or Contractor) <br /> B - -P `---(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 DEPART T USE ONLY <br /> APPLICATION ACCEPTED BY---------7.-t K-0 - --------------- -------------------------------------------- DATE------- 6 <br /> REVIEWEDBY-------------------------------------------------- ------------------•---- -------- --------------------------------------.. DATE-------- ------ <br /> BUILDING PERMIT ISSUED------------- ------------------------------------------------------------------- DATE. <br /> Aterations and/or recommendations--------------- - - ------ ------- <br /> a <br /> -----•-------------------------------------------------• ------ -------------------------- =--- ------- ------ <br /> } ----------------------------------- ----------------------- - - <br /> JJ a <br /> FINAL INSPECTION BY_� l ---- --- Date_............ <br /> fJ._., <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th4qeet <br /> Stockton,California Lodi,California Manteca,California Tracy,Califai'nia "�' <br /> F.P.CC. ` r^ <br />