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APPLICATION FOR SANITATION PERMIT Permit No. .z -/ <br /> tr --- - -- ------- - (Complete-in Duplicate) Date Issued -,-r.. 1 <br /> - This Permit Expires 1 Year From Date Issued ! / <br /> LApplication 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 <br /> L t � { County O/rdinanceN ..5-49. J tom✓ P <br /> iU , <br /> JOB ADDRESS AND LOCATION.- j � <br /> _x <br /> Owners Nam s <br /> s fPhone.-.rJ I... .._3 - <br /> Address .: j .y _. <br /> --- .. <br /> .. <br /> LContractor's Name .. - u-neJL/ - ---- ----- - Phone--- ---- <br /> Installation will serve: Residence 94/partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -. ... Number of bedrooms --Number of baths..I_.. Lot size ...- <br /> LWater Supply: Public system ❑ Community system ❑ Private Depth to Water Table 1h.. . ft <br /> Character of soil to a depth of 3 feet- Sand W Gravel 4 ❑,� E] [ISandy Loam ❑ Clay Loam V Clay E] Adobe F] Hardpan g <br /> - -- I No New Construction: Yes No �' FHA/VA: Yes No Previous Application Made: (If yes date___.... . Ly' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) h <br /> L Septic Tank: Distance from nearest weh_..h�._.-.-.-Distance from foundation-6._.....-...._.Material -'.ON-(A--E.. --.-_----.----`��'1 <br /> 0 f compartments-..-.- '_---_ <br /> -----__--Size-----, �-----------.Liquid depth --- . �$- Capacity---..-------------- v\ <br /> Disposal Field: Distance from nearest well.-jT P--.-----Distance from foundation---/-fl.-._--_----Distance to nearest lot line_2,Q.-._-. <br /> [�] Number of lines ----- ----------_._-_.__ -Length of each line--- -. .. .......Width of trench-j-9 <br /> to Type of filter material.-Q_L/r _.. ..Depth of filter material .._- .-.Total length---(__-� _--- --. IQ <br /> - <br /> Seepage Pit: Distance to nearest well-.1-[1 6 _._.--Distance from foundation-.-11- <br /> oundation [P ------ <br /> _.Distance to nearest lot line-1. .-._ <br /> Q Number of p1ts.-.I----__.-.._..-Lining materiala <br /> _ .0C__- Size: Diameter .1(-.7----_ ---Depth-j.r-- ..--...__--.. <br /> Cesspool: Distance from nearest well ---- ----.------Distance from foundation..... ---- --- _ Lining material..--....-___---..--._._------.-.. <br /> ❑ Size: Diameter- -- ----- --- --------- <br /> ------Depth--------------------- -------.._- - <br /> - - -----_Liquid Capacity----.-----------------...-gals. <br /> Privy: Distance from nearest well- ..... -_._------- _._------- ---- ----- ._Distance from nearest building------ --- ------------------------- `U <br /> ❑� Distance to nearest lot line-------------- --------------------------------------....-` ------------ ------- _. <br /> Remodeling and/or repairing (describe):....------ ----- - --'�1---.,-<� ----.7 .e--1v1tA-------- - , .----_r ------- \ <br /> ►- --------------------- --- - --- -------- - TT------------ ----------'---------------`-----'- --' -- ----- -- - -- <br /> - ------ -------------------- ------ ..../�y1 - <br /> --------- - - - <br /> - r-- <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 /> (Signed). �� W�7/- _ C -y .�✓.'. <br /> ----._...------------..--------------.-----.------------._-------(Owner and/or Contractor) ,. <br /> By:------- ------------------------------------------------- ------ -- -- <br /> ---------------------- -----(Title)--------- - -- -- --- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 1 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- _17j, -- ......... - --- -------- I- ---------------- ------- ------ DATE--- - <br /> - <br /> REVIEWED BY------------------------------- -- - - - - - - - .- DATE - -- <br /> - - - <br /> UI DIN PERMIT ISSUED.-- -- -- ------- --- -----­- -------- ----- ----------------------------------------- --------- DATE---- ------------------- ----- ------------- - <br /> A+erafions-and/o"emmm.,.dalicnrs,-..................._.._------------- ------ <br /> -..-----....-.... .. -- ...... ._._....... ... --....... . ..........--- ----- -----_..------------------------------------------ <br /> -- - - ---- - .-_.. -- ._ - --. --- - -- --- . . . . . .... . .. .. -- <br /> L -✓ ' - <br /> FINAL INSPEC f <br /> , ��!-'!`���- . . . � 7 Date.. <br /> - -SAN-JOAQUIN-LOCAL-HEAL-TH-DISTRICT --- - - - -- - <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi California Manteca,California Tracy, California <br /> E.H.92M 1-67 Vanguard Press <br /> L <br />