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i FOR OFFICE USE: <br /> 9 <br /> ___.__.,i.............................................. APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> ....... ................... ...........•---. ------. (Complete in Duplicate) <br /> Date Issued <br /> d - ---- - --- ---- This Permit Expires 1 Year From Date Issued i <br /> -3— ,ow,07 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Phis application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---- <br /> ----------------- ' f/ "/Lr...S� ..... <br /> Owner's Name .J-Z, '!_l 5........./11Tz-R- -1 f1Y � - ---------- ...................... Phone,7F_7 _% .... <br /> ----- <br /> Address .� .I J Q}------ <br /> Contractor's Name-------- ------- /" .........---------................................................ --7------ <br /> Installation will serve: Residence (D—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> s Number of living units: __ Number of bedrooms_37... Number of baths / -Lot sizeADZ.......... ................ <br /> U <br /> Water Supply: Public system ❑ Community system ❑ Private ❑[ —Depth to Water Table -------- ft. 1 <br /> e <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ED—Flay ❑ Adobe❑ Hardpan F��],,r <br /> Previous Application Made: (If yes,date..._-_ -, ..._. .) No ❑---New Construction: Yes ❑ No Q--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 /> i± <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation...................Material---------- ......................... ..._.__-.._. <br /> s [] No. of compartments----- --- -- ­­ Size----...­­--------------------Liquid depth.......... Cepecity ------------.._.. <br /> Disposal• Field: Distance from nearest Distance from foundation--/-a../......Distance to nearest lot line.-�_S3__._____ <br /> 0/ Number of <br /> h f lines. _ � .... . .F..J........Length of each Ilne. -- 9?y..................Width of tren.ch..._...—.. <br /> -----._._______--_. <br /> ' ..ypeo . erm .....Depth of flter materal_ f�__`'_ . Total length.. ...3d...`................_____..._ <br /> Seepage <br /> Pit: Distanc6 to nearest we.l./PiP-------.....Distance fr T foundation--4P;��-.--------Distance to nearest lot <br /> ❑/ � line..SU <br /> ------- <br /> IT <br /> - <br /> Numberof-s•t-" l.. ........ Lining material.-. Diameter_ -..-_--De to-i? )..��?..` .... ---- - a <br /> , <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material......... <br /> Size: Diameter- - ---- ---------------........._Depth..._..-------------------......._._...__.........._.Liquid Capacity gals. <br /> U .�.. ....� _- - , <br /> Privy: Distance 'rom nearest well..............._._.....__--.--._._-_--_____- -Distance from nearest building------------------------------------------- <br /> I ❑ Distance to nearest lot line..................... •---------------••--------------------------•-------•------------•-------------------------------------------------.-- i <br /> Remodeling and/or repairing �describe):.......i� .. - � -•---- . /j✓....... /i .l ---------------------------------- <br /> I .. <br /> ------------------------------------- -.. ------...---------------------------------------------- ...___..--- .---•--......•--•-------- ----------- -----------••--•----_-•---------•--•----••-•---•--•- <br /> ...... ----------•-------•-•--•---------- ......................................................--------------------------------------- ---------- -•-•------------•------ <br /> i 1 hereby certify that I have prepared this applicatio and'thaf--the work'will"bie-ilbWin accordance with San Joaquin County <br /> ordinances, State laws,.-and rules and regulations of the San Joaquin Local Health District, r <br /> y <br /> i ned �Jc°,e°1S� /��_ _ -------- ---- ------------•------ •-----....------------........ Owner and/or Contractor <br /> • _ - - - <br /> BY= t -- .. r .- .. —x� f--- - - {Title)... �C. -�= <br /> (Plot plan, showing size of iot, location o system in-relation fd wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- - -=,G.- -------------------------------------•---------------_ DATE---/Iq.'/.c3-'t/,-Sr................--------- <br /> REVIEWEDBY---- ------- ----------------------------- ................................................................................. DATE--------------------------.......................-........ i <br /> BUILDINGPERMIT ISSUED-- ................................ ----------...... ---­--------------­-- DArTE......... ......--•--•-------- ................. <br /> Alterations and/or recommendations:---------------------------------------------------------------------------------------------••---•-------n................................- ............... <br /> 4.......--••....................................................................................._....._.._..... <br /> ............._................................................................................................-----•-••----------- ------........................................................ <br /> T..-•-•. .................................................................................•---•--••---------.....--------.................. -- •-•-................................................................ <br /> T­ <br /> FINAL INSPECTION BY:... �--- - -• -•----- -- Date----/--10 71f.74, .......................... . ....................................... <br /> f SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ho:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> +� Stockton,California Lodi,California Manteca,California Tracy,California <br /> 7 <br /> y r.P.CC. yt <br /> )� S <br />