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EOR OFFICE USE: t/ ob _ �r
<br /> ...............................I............I............. APPLICATION FOR SANITATION PERMIT Permit No. .,�
<br /> ..................................................... (Complete in Duplicate)
<br /> ... This Permit Expires 1 Year From Date Issued Data Issued
<br /> Application is hereby made to the San Joaquin Local Health District for a permit to constri t and install 9 ork I3 rein escribed.
<br /> This application is de incompliance with County Ordinance No. 549. 0�., _020-0,61 ��,I'�
<br /> OS ADDRESS AND LOCATON .Ifl!°+l°+ l...o ,^r..jf ✓": ''.��t"'"' ....fir. Al.;171 ..�� _....
<br /> hr's Name._ .. ._. ' fit ............. Phone ................. .........
<br /> Address. r�.x '....s! .. ' `L'................_......... .................................. ....... »..»........_. S
<br /> Contractor's Na ,. ............ ».»................. ..............._...._.. Phone..............._.......... ....
<br /> Installation will serve: Residence kApartment House 0 Commercial ❑ jTrailler Caurt"❑ Motel ❑ Other ❑
<br /> Number of living units: ..;... Number of bedrooms.,... Number of baths r . - Lot size� �r ................... .. ...
<br /> r�,� �' 1
<br /> Water Supply: Public system C1 Community system [] Private �epth to Wafter Table,,.? . ft.
<br /> Character of soil to a dep#h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 9l. Llay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑
<br /> Previous Application Made: (if yes,date.....................) No Z New Construction: Yes �o ❑ FHA/VA: Yes --No❑
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1
<br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r .�
<br /> Septic Tan j: Distance from nearest well ;!',.,.....Distance f om foundation.."V........Mat�ri�»I
<br /> ...... •�
<br /> .. Size... Liquid dop,th.No. of compartments_.. ...... . p ty,i✓, ,e ._..
<br /> ✓_..,...-... Ca acr
<br /> l` r
<br /> Disposal Field: Distance from nearest we[111, 40..Distance from foundat' n../- r .._....Distance to nearest of line.•��......_
<br /> Number of lines...aw. ._... .... Length of each line_.dy ........,.......Width of trencl�i.r�...... . ..
<br /> j ........ ....... .
<br /> Type of filter materia -..Depth of filter material,/!��...__......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....................
<br /> ...Depth_..... .......... .. ........
<br /> Cesspool: ''Distance from nearest well._..............Distance from foundation...,.._..............Lining material..................................... r
<br /> ❑ »"Site: Diameter....................»................Depth..».. ..».... .. ..... _.. ....._ ..Liquid Capacity.--.. ....._� .,._. .gals.
<br /> Privy: Distance from nearest wEil...... ......................................I}itrt'ante from nearest building...................................
<br /> ❑ Distance to nearest Io# _ ..
<br /> /...,.r.
<br /> �`K/...._........_. ........ ......._............---....._. ...
<br /> y.�.._......._............_............... ......-................
<br /> CA
<br /> Remodeling and/or repairing ;descri'oe):.........,/iPi ... d✓ _. f!� /,i ce, -------------..,.»..».-_--,....». ....
<br /> ................. ............. »...,___.............».._..._.........._ .. ..,.... ... ..w_...._... ..»......»»,...»»....».................. .__ .._».......
<br /> .............................».._.»................---.................»»........._............._.........._»....................................................._..._.._..,.w.._... ..._.............---......_.-..
<br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Sart Joaquin County 4
<br /> i ordinances, State laws, and.rules and regula`Fions of the San Joaquin Local Health District.
<br /> {Si ned .............. . ...._"" ... r y� ✓..
<br /> 5 } rl._L/ ' ✓ r°............. .......»....._...........................-- 3'icriB�r Contractor)
<br /> By:----------- _ _...»» ..............._---_......._{Title)..�� rCi�!.. ._............................
<br /> (Plot plan, showing sizo of lot, location of m in relation to wells, buildings, etc., can be placed on reverse side).
<br /> ? FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY..... �.. ...»........................---......_---•---..._. DATE... .. ...`.._. ...........................
<br /> REVIEWEDBY..... .. %-.-..-».........................................................................,.-.......__........... DATE.._., ._....,........._....,........... ...... ....
<br /> BUILDINGPERMITy ISSUED._---.....»..............».......».»...»..............».,..............,..................w... DATE......»........
<br /> ...__._»_...,... ............
<br /> Alterationsand/or reeomrrrendations«.......,..........................».,»................»»...»_......,. .. ...-.................,.............------------_......... ....»
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<br /> .......................................... .j,..................................»......................................................»..........._..»»..............................,....I...........I.............
<br /> FINAL INSPECTIONEY %� �' '' ✓L ................... Date .l..Z.. . ...................
<br /> .. »....»...» ..........
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 1641 1.Hazelton Ave. 300 West Oak Street 134 sycareore Streoi 245 Wtrst 9th Street
<br /> Stockton,California r Lodi,California Mantecn,California Tracy,Colitonria
<br /> r.rb.cn.
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