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F R OFFICE USE: <br /> __________ APPLICATION FOR SANITATION PERMIT Permit No. __l.T�T.S�,I_ <br /> . . --../.... .................................. (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued bate Issued _ ?.1... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constru t and install the work herein described. <br /> This plication is made in compliance with County Ordinance No. 549. yll 11- 6 AlOR-T-H 0 F CppPERO�S <br /> -2 o /,), >We ul l rr-*O. �' f I <br /> - ....1.-..Q X- �`t. Q .N 1.....ON .- �---TT �.ol. <br /> n - --------------•----------- ------ <br /> JOB ADDRESS AND LOCATION.[�. <br /> Owner's Name....__YYV&-------- ......................................... ----------.`----------- --- <br /> Address-------------- -----•-----•------------------------------- ---------..................................-..................................................._...--.---------- ----- <br /> Contractor's Dame-------- --------- C--.-..-•----------------------------------•--------------- ------ Phone._`�6-.6..:`_9 6 D7--- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [:1 Motel [I Other P9 C'HtaK c.00 A1 <br /> Number of living units: -------- Number of bedrooms ........ Number of baths .-- Lot size ..Lk� ------ --- ---------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. I. <br /> Character of soli) to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay U Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date-----------------—1 No�1 ` New Construction: Yes ❑ No V FHA/VA: Yes ❑ No)0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: " <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation---------...........Material......................1-_--------_-...__-_-_---- <br /> [] Eqe� No. of compartments..........................Size................................Liquid depth......................... Capacity-- -_--------_.---- <br /> Disposal Field: Distance from nearest well.................Distance from foundation....................Distance to nearest lot line.... ............ <br /> ❑ E , t'_ Number of lines_....................... .......Length of each line.............................Width of trench------.-- •,_-----.-------------- � <br /> Type of filter material..............._-_-.-_._Depth of filter material....____--_-..Total length................� ------------- N <br /> Seepage Pit: Distance to nearest well-..I-o.Q-�..- Distance from foundation_...--1-G2_�-__--.Distance,to.�earest.lot line....S_-.�..-... <br /> (A Qpj4- Number of pits..._--_-A..........Lining material..S..,-/J�0C.K__.Size: Diameter.... 0"--..--.Depth-----------AS................ <br /> I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material------- .._.-.--..._-_---.-.-.-. <br /> ❑ Size: Diameter-------------------- .............Depth..................._.... ---------------------Liquid Capacity. -------------------------gals. <br /> r � <br /> Privy: Distance from nearest well------------------------------ Distance from nearest building. ............._.....__-----_._-__-------- <br /> ❑ Distance to nearest lot line---------------------------------- ------------------------------------------------------ .................................. <br /> Remodeling and/or repairing (describe) Aj�------- C1-----Q X..,S .1-'' -sti••-------cS _ - 'Vn...c................................................ <br /> ---------------------------------- --••-------._...-•-----•------------------- - -1 ..................---------------• - --... <br /> lid <br /> ------- ----------•-•--•--••-----------------...-.-..-.---------------------------- ---------------------............I......................--.-.-••--•--••--••-•--_...---- -----------.....-.-........------ i� <br /> --------------•----- ....._..-------------------•--•...-_...._<....------------•------------------------............................-----------------------------------------------......................._............. <br /> 1 hereby certify that I have prepaied this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> 1 " ----------.)- �relafion'­f. <br /> C-=-. ------------------------------.- ------_...._.-..--- O nor and/or Contractor <br /> (Signed) { ) / <br /> V.- <br /> By: 0 4- <br /> -----------------------------------(Title)---------- s <br /> f <br /> (Plot plan, showing size of lot, location of sysl&, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- ......... .. .. 's' -------•--------------•-_------•-- DATE--- ------�._7............... <br /> REVIEWED BY.-- - ............ DATE- - <br /> BUILDINGPERMIT ISSUED..................._-------- j - ------------------ - ..... DATE------..._..............-•--•-. --........................ <br /> Alterationjr and or recomme ns:. -----... .. ---•-------------------• -••------------------------------------------------------------------- <br /> tol ------ <br /> I11 <br /> ....................... <br /> ......................... ------ . . <br /> ...................................... - i ..1'.._-....-....--.-.- ..-_.--..._--....---...-....... <br /> _.--..-_ ....................... ............... <br /> FINAL INSPECTION BY:.. L" 9 ..................... ........... Date.... ..�UI -----......----------------------.----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1.Hat:elfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVIGIC 8-59 3M 3-'63 F.P.CM �° <br />