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FOR OFFICE USE <br /> - <br /> --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------------- ---- ------------------- 1 7 /,0//,,_Z�/ I <br /> ----------------------------------- (Complete in Duplicate) Date Issued ..---------------- <br /> ----- -------- <br /> This Permit,Expires I Year From Date Issued :Z_qR--/y0_ 2- <br /> ------------------- District for a permit to construct and ir;6Wthe work herein described. <br /> Application is hereby made to the San Joaquin Local Health <br /> This application-is-made_In. compliance with County Ordinance No. 549. <br /> 010 <br /> a--------- wwv�_,/ <br /> JOB ADDRESS AND LOCATION---1 -A <br /> Phone-_ © <br /> - -------- <br /> -------------------- <br /> e <br /> Owner's Name------------ <br /> ------------------------------------------------ <br /> -------------_---- -------.......... <br /> Address-------- ------------------_------------------------ --------------- <br /> Contractor's Name-------- ---- ------------------------- I----------- ----------- ---I----------------------------------- Phone------_--------_---------------- <br /> Instal.laiion will serve: Residence Apartment House E] Commercial El Trailer Court ❑ Motel [:] Other [I <br /> Number of living units: Number of bedrooms -9- Number of baths Z.-- Lot size A94,e_4:r--------_---------------........... <br /> Of <br /> Community system Depth to Water Table Waft. <br /> Water.Supply. Public system 0 Comm' stem 50,115�riyate p <br /> Character of soil to a depth of 3 feet: Saind E] Gravel C] Sandy Loam 0 Clay Loam ElClay 0 Adobe [] Hardpan I-] <br /> 11� 1 @R--'N <br /> Previous Application Made: (if yes,date-----------7---------) No 090New Construction-, Yes 0-110 -1 PHA/VA; Yes o <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 0 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 'ell ion----100W--------Material-----4- & <br /> Septic Tank: Distance from nearest w Distance from founclaf <br /> ----sizej- ----'-------------Capacity ZZ -—------ <br /> ---0-,? vX-4eiquid depjh <br /> No. of compartments-­.�Z---- I - j .1 � $ <br /> 0-'t _4- from foundation--ze----------Distance to nearest lot kne-_J---------- <br /> "I Field: Distance from nearest we --.---—--------Distance <br /> Disposal -------------- <br /> Number of fines..----A---------------- �Length of each --------ov------Width of trench- -------- <br /> 6 oaf filter material------ -------_Total iength____A��------------------------- <br /> Type of filter material.5Weydz,,44��be�lt I <br /> �-.1 to nearedlMR161--o---------- <br /> Seepage Pit: Distance to nearest well------------------Distance from folj0dafion____-1_�---------Distance t -0 -1 <br /> Number of pits----A--------------Lining mater'.ial-l-�&CA6-Size: Diamefer-_--n. ......Depfhw.Z4A:-V-'k�- - <br /> Cesspool: Di;fance from nearest weil------------------�Distance from foundation_------------------- Lining material-1.777 Tfkl�--------- <br /> -------- als. <br /> ------- --------------------------- Capacity <br /> ----------------- <br /> El Size. Diameter. <br /> rest bZicr, -T __' -------------- <br /> Distance from nearest well________________------------------- --Distance from nearest ng <br /> vy: <br /> Distan"ce to nearest lot line----------------------------------------------------------------------------- ----------------_.. ------------------------------------------- <br /> (describe].:----------- ------- --------- ------------------------------------------------- <br /> Remodeling and/or repairing _151kla --------- <br /> ---------------:-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------- <br /> ---------------------------------------------;------------------------------------------------------------------ -------------1------------------------------------------------------------------------------------------------ <br /> -------- -------- <br /> ------------:---------------------------I--------------­------------I-------------------- ------------------------- <br /> ------------------------------------- --------------------------------------------- <br /> IT <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 /> ----------------- or Contractor) <br /> (Signed)------------ I-------- - - -----re"--------------------------- ------ ---------------------------- ------------- <br /> -7 ---------------- - --------------- <br /> 7— —"----- ------------------------ <br /> ---- -------- <br /> By%------------------ --------- --------------n-o-f-_s�-�emiin relation to wells buildings, etc., can be placed on reverse side). <br /> (Plot plan. showing size of lot, location <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- - --------- --- --- ------------- ------------------------- DATE.----------------------------------------- ---------- <br /> ------- <br /> REVIEWED <br /> ATE---------------------------------------- ------------------- <br /> REVIEWED BY-------------------------------- •-------1-------- ---------------------- --- ---- - ----- ----- ---------------------- DATE--------f <br /> f...... <br /> BUILDING PERMIT ISSUED ..... <br /> DATE------------------------ ---------------------------------- <br /> Alterations and/or recommendations:----I----- ---------=------------------------------------------------------------------------------------------------------------ ---------------------------- <br /> -----------------I----------------------------------------------------- -------------------------- ------------ ------------------------------------- ---I------------------------------------------.................. <br /> -------------------------- ------------------------------------------------------------------------------------- <br /> -----------I--------------- ------------------------------------------------------------------- ---------- <br /> -------- ------------------------ - ------------ -------------------------------------------------------- <br /> -------------- ------------------------•-------------------------------------------------------• ----------------- <br /> ------------------------------------------------------ <br /> --------------I-------------------------- ------------- -- --- --- -------- -- --- ---------------------------------------------------------------------- <br /> ----- --- --- <br /> ----- -------- ------------------------------ <br /> 0--- 3 <br /> FINAL INSPECTION BY----------. ­ -- ---------- -- ------ -------- ---- <br /> Dat e--------/ --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Amer,icon Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> REVIECD 9-59 F.P.00.2M 6-60 <br />