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FOR OFFICE USE: <br /> ------------------------------------------------------ <br /> - - <br /> APPLICATION FOR SANITATION PERMIT Permit No. ��-.��a9 <br /> ----------------- -------------------- ------------------ <br /> (Complete in Duplicate) bate Issued <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. 5549. ("�(:_5_(03_1,t�/-� <br /> / — <br /> _;Z <br /> JOB ADDRESS AND LOCATION-------------Z",91 ----- - ----- --- �-� " A -2 -oY <br /> Owner's Name------------- - -----------(Te � - — ---------------------- Phone--- -----9�_,3 <br /> s � <br /> Address-------•------------/ t------------- -- ----- �r cel---r--..C. <br /> Contractor's Name--- G3 --------* � ------------ , ---------------------- --- (' ... Phone. 9-,3a^' f <br /> Installation will serve: Residence ®/partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> / '/t <br /> Number of living units: -------- Number of bedrooms __7 Number of baths A.��ot size ---141_ )(--------f Y.__- -----_ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. �! <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0. Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FNA/VA: 'Qs ❑ I�No ❑ <br /> r` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> :ter (No septic tank or cesspool permitted if public sewer is available within 200 fee�et. <br /> F'� ] / <br /> Septic Tank:-- Distance from nearest well <br /> QQ.----Distance from foundation__ __ �?__._.__._Materiai_... - ' <br /> -------- -- ------- - <br /> ❑ No. of compartments_______cc��.-- ----Size___ __r __S.._.._Liquid depth-------�--------------Capacity...�Q_ <br /> Disposal Field: Distance from nearest well...4-QQ_.... <br /> Distance from foundation_.-.-e.Q_1---.Distance to nearest lot line---5 �_---- <br /> ❑ , Length of each line------ ----------- -F- Width of trench-----__a4.- -•----------------- <br /> Number of lines----- - ------------ ---- <br /> Type of filter material__:__� 'fit_r-�epth of filter material__---_1_ ...-__Total length_-______ _ _________ __ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----____---...- <br /> ❑ Number of pits----------------------Lining material--------------------- Size: Diameter-----------------------Depth---------------------------- - -- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------------.--.Lining material--------------------------;: <br /> ❑ Size: Diameter-- ------------------------------ ----Depth---------------------------- --------------- ------Liquid Capacify----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-..__---__-_--_..________------..----- <br /> ❑ Distance to nearest lot line----------------- --------------------- ------------------------------------------------------------------------------------- ------------- <br /> Remodeling and/or repairing (describe}:---------------- ------------------------------•--------------------------•----------------------------------------------------------•--- ------ <br /> ------ ------------ - ------ ---------------------—---p-----g-----------pp------------------------------------------------------------------------------------------------------ --------- --- ; <br /> I herebycertifythat I have prepared this application and that the work will be done in accordance with San Joaquin 'Counfy <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed}_ _ 1'S - � ` (Owner and/or Contractor) <br /> ---------gyp- -- -- - ----- ---- <br /> BY� [. -=Q. ►..4.-�:• -------------------------------------------------(Title) - <br /> ----------- <br /> (Plot plan, showing size of lot, location off system--iiireiaf�ion to-we11s;buildings,,etc:;can be placed on reverse stile}. <br /> FOR DEPARTMENT USE ONLY <br /> V WED BY :.. - ------------- --------------------- --------- DATE �' -I -- <br /> APPLICATION ACCEPTED BY_--- DATE--------- ------------- <br /> REVIEWED <br /> ------------ <br /> RE IE - <br /> BUILDINGPERMIT ISSUED--------------------------------------- -----------------------------------------------------------.-. DATE----------------------------------------------- ------------- <br /> Alterationsand/or recommendations-------- - -------------- ------------------ - -------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------•------------------------------------------------- ------------ <br /> ------------------------ -------------------------------- ----------------------------/------------------------------------------------------------ ------------------------------------------------------------------ <br /> ------------------I------------------- -----------------------/�- - -- ------------------------ --------------------- ------------- - -------­------------------------------------ <br /> FINAL INSPECTION BY ------------------------------------- <br /> Date = /-6 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street„ <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />� q <br />