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APPLICATION FOR SANIT�TION PERMIT ---- Permit No. ..._�3 Z
<br /> • � d (Complota in Duplicate) r
<br /> 1 This Permit Expires 1 Year From Date Issued - Da+e Issuedvzo
<br /> ' Application is hereby made t the San Joaquin Local Health District for,a permit to construct ans�tell the work rein described,
<br /> Tf,khis application is ade in,co pllance with County Ordinance No. 54
<br /> JOB ADDRESS AND LOCA ON.._.... .... (� � U.cLLu
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<br /> ; ........ y _ "'Owner's Name...... ....... .......... .....•-----------.------------- ...................... Phone...------........... » ......
<br /> Address.. _ - 424 '6 —
<br /> ' Contractor's Name--------- ..._..-_....-----..........................._... ._..........._f_....-.---.e._ l Phone _ :f
<br /> Installation will serve: Reside e ❑ Apartment House ❑ Commercial ❑ Trailer 071,10
<br /> t rt ❑ •Motel ❑ Other
<br /> Number of living units: ...... Number of bedrooms ....... Nufnkiar. of bath` . .,.. Lot size
<br /> e •• - - ,..
<br /> -.......... -
<br /> Water Supply: Public system Community system ❑ Private 61.Depth to Water Tableft.
<br /> Character of soil to a depth of.3 feet.- Sa�nd�' Gravel ❑ trnd"y,Loam Clay Loam❑ Clay❑ Adobe❑ Hardpan❑
<br /> Previous Application Made: Y s ❑ No p` New Cons}ruction; Yes No ❑ FHANA: Yes ❑ No❑
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cessP+1ool permitted if public sewer is available within 200 feet.)
<br /> Septic T Distance fry m nearest well.4d_I_�Distance from foundation--,ZO.�,..••.....Material. . .. �cs -,,.-..-.--
<br /> ' No, of colrlpartments...,.j.14-2------------- .�.. r6t...._�.iquid(depth.....�..............Capaci+y.,r.,c�fdQ
<br /> A
<br /> Dispose geld: Distance from nearest weII.S ..........Distence from foundatio .��....!_..,Distanca to nearest lot line..._............
<br /> Number of lines........ � rr
<br /> •ar(.-:,/_�.._..�. Length of each line..fr��_ri ; ..Width of trench....ae�.. .............Y_:_..-- ,� .
<br /> Type of fill Dr materlal._ ,QktyE._.Dapth of fil+er ma#e nal...�s ...._ .... length_.____..•.
<br /> Seepage Pit: Distance to nearesf well-�...___-._-_.-_..Distance from foundation......._.._!.__Distance to nearest lot line................ It,
<br /> ❑ Number of pits........•_.......L_-Hnieg. n ateriaL_.-- -:_-:-^Sze: Diameter...........--.---.-..Depth__........,_....,.....-_-.-.... 1 ,
<br /> ' Cesspool: Distance f m nearest well_.;............Distance from foundation....................Lining material......
<br /> ❑ Size}: Diamiter_--'--..--' '.::.= .Depth..kk :...... _ ..........................Liquid Capacity,......—..................gals.
<br /> Privy: Distance fr m nearest well............_..............A................Distance from nearest building.......-.._..................._.........
<br /> l - _ - - ,t s
<br /> ❑ Distance neares# lot'line---...-•----•---................--------------------..........._.------------_ _................
<br /> r ................'--
<br /> Remodeling and repairing lescribe):___,,Q%...... .......�--_- -- !
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<br /> ;�v ' I hereb rr+' That I hav
<br /> y,x * prepared this application and the+the work will be done in accordance with San Joaquin County
<br /> ordinances +a} laws, and rules a regulations of the San Joaquin Local Health District. a
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<br /> (Signed). ... .. _.. ... ------±_.... !-- ---------------••-------------------.-.. ....---- Owner and/or Confraetor)
<br /> » ' y'.... - -- IT ------ / i---..._.._..-..._..........
<br /> 5 ,(Plot plan, stewing size of lot, I9cation of system ' relation to wells, buildings, etc., can be placed on reverse side).
<br /> FOR DEPARTMENT USE ONLY
<br /> ' `f APPLICATION ACCEPTED BY --- ---— ........................................._._.....__......._.....,._ DATE.._.......---........ --- ---
<br /> (',`REVIEWED BY..._.�.._............- ----- --•--..__.........--...-•----•------------------...........---_._ DATE...--........
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<br /> BUILDING PERMIT ISSUED--------- - — — -- --- ___,,,_......_._..._..............._.. DATE...-, ....... - — - ---------....
<br /> Alterations end/or recommends 'on .........................:........__--,...----•-...._ -......... ..-,.......----.......—..._.------...--
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<br /> FINAL INSPECTION BY:.......
<br /> .................................... ....,...........-..__.,.,.._-----....__...------------.
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<br /> ..G ......................................... Date._......__ /...-.--------.------------•-•---
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT /
<br /> 130 South American Stmt 300 Wit Oak SMet 137 Sycamore Sfroat 014 North "C•' Street
<br /> Stockton, California Lodi, Cal1furn;&z44 Manteca, California Tracy, California
<br /> ES-9-2M Revised a-•59 FYZOC
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