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rUK Urrl t t: <br /> ------------- ...___- APPLICATION FOR SANITATION PERMIT Permit No. <br /> - --- -- ---------- -------- (Complete in Duplicate) <br /> ........... . This Permit Expires I Year From Date Issued Date Issued -_._-._/_ <br /> OF-3 r ?D-1o.6 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instafi the work rein described. <br /> This application is made in complia a with Count Ordinance No. 54 . <br /> JOB ADDRESS AND OCATIO ...... <br /> r Cam- q ............ <br /> Owner's Name- - -1�!�---_.- _- - - ------- -_--..--•---•--•-_ --_---•--•• - ..... Phone..--•----•--•--------------- <br /> Address--- ---. -�----i . ....... ....... ` l�GZ._r_�_/�-r.�_.ftat�..�_- �lm._r._. ..... �O.v� � <br /> Contractor's Name.-- •. ......-- 1IR4.1 �1 1�-.�4 ..... -------_--_----------------- Phone.._A?. ......6,;Aff�� � <br /> Installation will serve: Residence ®-partment House ❑ Commercial ❑ Trailer Court ❑qMotel ❑ Other E]Number of living units: _./_ Number of bedrooms ..2- -Number of baths Z... Lot size ..G/�Z _ _______ _________ -_- ........... <br /> Water Supply: Public system ❑ Community system ❑ Private,eDepth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] San cam E] Clay Loam ❑ Clay❑ Adobe erdpan ❑ <br /> Previous Application Made: (If yes,date....................) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! <br /> is T Distance from nearest well....... _. <br /> ..........Distance from foundation. __...__-_-_.-----Material_-____...-__........._............._............. <br /> �C�y� No. of compartments..........................Size--------------------------------Liquid depth..-------------- ----.._._Capacity--------•---•--•`------- <br /> sp al a: Distance from nearest well.f_ .� Distance from foundation....! -_-•.__.Distance to nearest lot line- A.14 '-_. <br /> J Number of lines....... <br /> ___Length of each line.--_�r_Q.�.........Width of trench._4-f <br /> 4-A 4 Type of filter material.. ' Depth of filter material.......,( .._ Total length-_---_-------------- <br /> Se ________ __(a__•. <br /> p IZ70___..__..-6stance from f undation._.. <br /> e Pit: Distance to nearest well. �i.Q.......Distance to nearest lot line___._.f_�� <br /> Number of pits____.._..._..._....Lining material___ . ;-...Size: Diameter..... ` --..._.Depth.....t> _ !............ <br /> j <br /> Cesspool: Distance from nearest well-----------------Distance from olundbtion........---------_Lining material..................................... <br /> [] Size: Diameter..................... .•-------------Depth----•- -- ---------•--.----------......--•........_Liquid Capacity_ ..........................gals. <br /> Privy: Distance from nearest well.............................. .......Distance from nearest building___._...-....._.._____--_.--_._...__-.___� <br /> ❑ Distance to nearest lot line-------------------- -•-----...------------------------------------- <br /> Remodeling and/o r repairing Idescribe1:_---- - ...............................---------- .._. -------- <br /> ..................... <br /> ..................... <br /> ..-....-•-•--•---------------------------------• -• --- .--••--. ----•------... <br /> - - ----- -...... ----•----- i <br /> I hereby certify that I have prepared +his application and that+ e work will be done in accordance with Sen Joaquin Coun <br /> ordinances, Stat s, an rules and regulations of the S Joa din eel+h District. <br /> �' " ' <br /> (Signed) ------ 'rq - ' " �-Contractor) <br /> B __ <br /> (Plot plan, showing size of lot, location of system in relation to uildings, a ., can be placed on reverse side). <br /> FOR DEPA MENT USE ONLY <br /> APPLICATION ACCEPTED BY...... ----•--•---- ---------------------------- DATE___T`---- --I--- -.---0. <br /> REVIEWEDBY --------------------------------------- -------•----------- •--------•-------._ DATE... .. <br /> BUILDING PERMIT ISSUED............ - ------------•---- ------ DATE--------•--------------------- <br /> Alterations and/or r om endetions:............... . I z ... . ------- <br /> ,... <br /> —_..---------- --------------------- ---- .... ..... . <br /> ... ..... .._•-••--•--- r <br /> -------------........................................................... <br /> ........ .. ..................._..----...--------....................... ------------------------------............... .......... ------------•-------------......---- ------------------.................__......... <br /> FINAL INSPECTION BY:.. .�J Date-- ---//---........... .CP Z <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Ei 9 REWSEo e-59 RM 5-E1 At LA9 <br />