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FOR OFFICE USE: <br /> .-_ .. -- <br /> ------- <br /> ----------- ---------------- _ ----------- APPLICATION FOR SANITATION PERMIT Permit No. AL_5_-F-7_. <br /> 17-------------------------------------- •----- --------- (Complete•in Duplicate) ��I�_(o r/ <br /> ........ This Permit Expires 1 Year From Date Issued Date Issued ________ <br /> Application 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 County Ordinance No. 549. i <br /> i <br /> JOB ADDRESS AND LOCATION 1.053 �-------11�l-1 <br /> . _' - <br /> }� /� <br /> -------------- <br /> Owner's Name_ ------------- -- `--•--W...`----- l t_ �- ---------- -- ------ Phone4W---7- �'7--x <br /> Address_ <br /> --yo z.-. --------- .L_P_Q_IV ----- R- _...... <br /> Contractor's Nams__ [Juf11 __-_--- ----_ <br /> -•-•-••-- ----------------------------------- -- - -- ----------------------------------------------- Phone----•- -•--•----•-------•---•------ i <br /> Installation will serve: Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ __-_ Number of bedrooms 2—Number of baths_ _-._ Lot size <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 1.304_ ft r <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--..--.-- ------- ) No New Construction.-Yes ❑ No [A:6�A/VA: Yes ❑ No ®� <br /> TYPE OF INSTALLATION AND SPECIFICAT.IONS:= z _... <br /> _ .(No septic tank or cesspool permiffed if public sewer is available within 200 feet.) <br /> Septic Tank:- -Di'stance from nearest well___.-------------Distance from foundation___________________ Material <br /> No. of compartments-- ---------------------Size----------- - -- ---_-=--------Liquid depth---- ---- ........Capacity--------- ------------- <br /> Disposal Field: Distance from nearest weil_.:.50----Distance from_foundation__w _Distance to nearest lot line___��_7_____---- <br /> -jtd - Number of lines � --------------------Length of each line__ ----5Q__.`.._.__._.Width of trench...__ 6 "t <br /> tc _ / ------------- <br /> Type of filter material-- _ _Q_��..___Depth of filter material__..-17-_------Total length------..._.1S- --------------------- � <br /> Seepage Pit: Distance to nearest well-----------------------Disfance from foundatio----------------- Distance-to-nearest lot line_____.._____..-- <br /> ❑ Number of pits-- -------------Lining material-------------- -., Size: .-Diameter-----------------------Dept h-------------------------------• �U <br /> Cesspool: Distance from nearest'well ________________Distance from foundation-..._............ ..Lining material----------------------.-.______...__. <br /> ❑ Size Diameter- ----------------- ----------------Depth--------=---- ---------------------------------- Liquid Capacity-. ------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building-_.___.___._____._.___-_------....___.. <br /> ❑ Distance to nearest lot line-------- ------------------------------------------------------------------- <br /> Remodeling <br /> ----------------------------------Remodeling and/or repairing (describe):-------------------------------------- ----------------:- - -._._ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------- r <br /> ---------------------------------------------------------------------------------------------------------------------------------------------- -- --------- <br /> I hereby certify that I have .prepared this application and thaf the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ; • ------------- -- ------- ---------------- --- <br /> - -----------•------------------------------- -----(Owner and/or Contractor) <br /> Y.-----------------------------------� :_--��-::-_--------------- ----_--�-------------- --�{Title}. -- - -------------------- <br /> i � <br /> (Plot plan, showing size of lot, location o `system in relation to wells, buildings, etc., can be placed an reverse side). <br /> k, <br /> 1' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY i - �Q-� - - - DATE <br /> REVIEWED BY------- --------------------------- - ---------------------------------- DATE---- - - <br /> BUILDINGPERMIT ISSUED-------- -- - --- ------------------------------------------------------------------------- --------- DATE------------------------------ ---------------------- <br /> Alterations and/or recommendations:--------- - -------------------------------- ------------ ----------------------------- -------- <br /> ------------ <br /> ------ - <br /> ------------ ------------------- - _ <br /> ------------------------•----.------------- <br /> - l <br /> -•--------------------------- - ----------• ----- ------ <br /> -------------- - --- --- --- - <br /> __­/---------------------------------------- ------ -------- ---------------------------- <br /> ....................... ..-- ----- - <br /> FINAL INSPECT IO ....... -- c!/ _-- ----. -- . ZS` <br /> Date_- --------------------• ------------- -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 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 />