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FOR'OFFICE USE: <br /> --------------- ---- --------- <br /> _-_-- APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete-in Duplicate) '•b; i <br /> ...-- ------ -- ----- ---------._... - Date Issued <br /> --------------------------- This Permit Expires 1 Year From Date Issued t <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the. k.,herein described. <br /> This application pp on is made,in compliance with County Ordinance No. S49. <br /> .i <br /> .JOB ADDS NDf/ ATfON 7 - 1 1' :j� -- --� `'"�-` / <br /> Owner's Name--------- <br /> [.S__ e:,111..._.. e Ie.fe ' Phone.! f__ <br /> ` l iM Tcx � Y�-- -�+ <br /> Address-_ 11- � ' - -- / <br /> ---------- ---- <br /> j Q �� - <br /> i <br /> � I <br /> Contractor's Name.-----. Phone--y__.•----•------- --------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commei:ci6lltl-"-TT d ler,�Court ❑ Motel ❑ Other ❑ i <br /> Number of living units: r. ----- Number of bedrooms _%3.-- Number of baths -------- Lot size _ _- .C - f , - '-------------- <br /> Water <br /> -______ __Water Supply: Public system ❑ Community system 0 Private ❑ Depth to Water Table ------ _ ft r <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam [IClay Loam ElClay ❑ Adobe E] Hardpan ❑ <br /> Previous Application Made: (If yes,date-----------.--_...- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [ V- <br /> TYPE .OF INSTALLATION AND SPECIFICATIONS: �_ <br /> (No septic +ank cr cesspool permitted if public sewer is available within 200 fee+.) �. I <br /> ._" l } 7 _ <br /> Septic Tank: Distance from nearest well_` ._..Distant//e from foundation_.._- --4t...---..Material ---___�'A��-�:�-�.-�,�-----1 <br /> No. of compartments...--._._�---- ----Size----4?- 9' b 1� `Ligtaid depth Capacity__f*�-- .--- <br /> Dis o al Field: Distance from nearest well__6V_._:._Distance frbm foundation----/,�.__._.-.Distance to nearest lot line....�____-__., <_ <br /> ® Number of lines----- Length of each line___ -a_-_._ <br /> Width of trench I <br /> 1 OG Depth of filter material---- - - '`Tot h,-length--..' ..140------------------------- ---=----------- <br /> Type of filter materials.....-_-. p � { - <br /> Seepage Pit: Distance to nearest well...._._._.-__..._._-Distance from foundatio <br /> r <br /> Distance toynearest lot line_.__.___-_-_-.._ <br /> ❑ Number of pits. Lining material------ ------------ Size: Diameter.-----•---------- Depth------------------------------- <br /> e V - 1 <br /> Lining material_._.--__-___._ ` <br /> Cesspool: Distance from nearest well ________________Distance from foundation-.-_-__..-_.._-_ - <br /> ❑ Size: Diameter- -- -------- - - - ----------------Depth_..----------- ----------------------------------Liquid Capacity------------- --------------gals.l: <br /> Privy: Distance from nearest welt------------ ..----------------. ... _---.-..Distance from nearest building_--__--------- -- <br /> ❑ Distance to nearest lot line _------------ -- ---------------- -------•----------------------•--------------------------------------------- ----------------- ' <br /> F- *N�---«--- �pXO------40- �-F--- ����_x�-�� �P[�M----•- <br /> Remodeling and/or repairing (describe}:__.�.�_ _ _______ _ _- - - - --- - - - -- - - - / - - <br /> _ y <br /> - - ---------------•-BAY----Of----)-w--Tx4op----•-------- --------- --------------------------------------------------------- ----------------- <br /> -----------------------------------------------•-------- ------ --- <br /> ----­­ -- <br /> x <br /> --------------� - q i'_.- ----- ---------- - - ----------- - <br /> I hereby certify that I have prepared this application <br /> and that +he work will be done in accordance with San Joaquin County <br /> - <br /> f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> - - Owner and/or Contracfor <br /> (Signed) �� /7 ✓ �' -. . / ) x-------- <br /> - - - __. � ,..��. - -� ... Title}_ ------ -------- <br /> ------f .� - -------- - - <br /> (Plot plan, showing size of lot, location of system in relation to we'l1s, buildings, etc., can be placed on reverse side). .• <br /> -. <br /> FOR DE ARTMENT USE ONLY <br /> rt <br /> APPLICATION�P���� ------------------------- DATE._._. J�P�__ s ---------- ----------------- <br /> REVIEWEDBY - --------------------------- DATE--.-- ------------------------------------------------------ <br /> REVIEWED 1 BUILDING PERMIT ISS <br /> UED.------- -- -------------------- -------------------- ------------------------------- DATE----- ------------------------------------------------ <br /> Alterationsand/or recommendations:_---- ---------- ----------------- ------------- ----------- --------------------------- -- ----------------------------•------------- ...----------•- <br /> •• •-•-----•-----•------ ----------------------- -- ------•----------------------- ----- --------------------- ----------------------------------- ----------------- <br /> FINAL INSPECTIO BY:_. -_ ;,-a��---- - ----- <br /> ------ Date - __0/-- Sal :� ------------- -- -- ------------- <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1 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 /> ` E.H.9 2M 1-67 Vanguard Press <br />