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FICE USE: <br /> r--- � <br /> ------------ ----------_-------.--------.-----.----.-- - APPLICATION FOR SANITATION PERMIT Permit No. -ZE <br /> " --------- [Complete in Duplicate) <br /> --- ---4-70--- - - ----- - =/ <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. <br /> JOB ADDRESS AND LOCATION.;_ d_ _--_- <br /> Y --- ----------------------------------------- Phone------------------------------------ <br /> ----------------- <br /> ----- ----•----------------------- <br /> Owner's Name----*_AA---- <br /> Address--------�d--`f�'------�-r-b--------• �---� <br /> -----------------•--------------- ---------------------------------------------•----- ---•-------• ----• ------ ---- <br /> Contractor's Name --- `-- T -- ---------------------------- -------- --- Phone--•---- <br /> ----------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel p Other ❑ <br /> Number of living units: -_-r<---- Number of bedrooms ----- Number of baths r------ Lot size <br /> Water Supply: Public system [-Community system ❑ Private ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe [}f196rdpan ❑ <br /> Previous Application Made: (If yes,date--------------- ----) No LK' New Construction: Yes 0 No -FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Distance from nearest well-----------------Distance from foundation--..-__------__----.Material_---.._---.---____..--_-_._ <br /> No. of compartments---------- ---------------Size--------------------------------Liquid depth--------------- Capacity <br /> Disposal F' 10: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line-------.--------- <br /> Number of lines-----------------------------------Length of each line----------------------- <br /> ------.Width of trench------------------- <br /> Type of filter material-------------------------Depth of filter material-_ _ <br /> .-------__---------.Total length-__------- -----_-_ --------------- <br /> .- <br /> -------------------- <br /> eepage ;#-: Distance to nearest well ___-----__----------Distance rom foundation---/a----_-----.Distance to nearest lot line .-_�____ <br /> Number of pits------(--------------Lining material-_.` / _GAC-----.Size: Diameter------ -.3- ------Depth--------�_S'• U <br /> Cesspool: Distance from nearest wefi-----------------Distance from foundation--------------------Lining material-------------------- <br /> ____-._ <br /> Size: Diameter--------------------------- ---------Depth----------------- ----------------°-----------------Liquid Capacity---------------- ----------9al--X q <br /> Privy: Distance from nearest well-_-------------_-.--------------.----_--_-----Distance from nearest buildings. <br /> ❑ Distance to nearest lot line------ --------------- - ------ - ------- ----------------- -------------- -- <br /> Remodeling and/or repairing (describe)-------------------------- ---------------------------------------- <br /> -----------------------•------------------------- -------------- ------------------------------------ /fo <br /> ----------------------------------------------------------------------------------------------------------•---------------------------------•---------------------------------------------------------------- -------------- <br /> ----- ------ - --- ----- ------ - --- ----- <br /> I hereby certify that I have prepared this application and that the work will be- done in accordance with San Joaquin County S <br /> ordinances, State laws, and rules a d re ulations of the San Joaquin Local Health District. <br /> (Signed) `pl` - ---- ------------------------------------(Owner and/or Contractor <br /> By:------------------------------------------------ ------------------------- - - Title . <br /> - - -- - ------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- _:f _ ---- - �t G-Q- DATE-- �'-f_ � <br /> -- ------ --REVIEWED E - -----------------------------------IS ----- -- ------. DATE----------------------------------------- <br /> -- -------------- <br /> UILDING PERMIT ISSUED DATE- <br /> Alterations and/or recommendations:__ -�-: -... �c-C ------------------------- <br /> r1r - ---------- <br /> ------ -�.----- =�- - ------------- - ------- ----------------- <br /> ------------- ---------------_---------------------------- <br /> ---------------- --- <br /> ------------------------------------------------------------------------------------------------------------------------- ----------------- -------- <br /> ---------------I--------I----- ------------- ---------------­_­------I-------- -------- ----------------------------------------------------------------------------------------------- ------------------------------- <br /> -------------I-------- ------ ------ ------------------------------- ------ ------------I-------------------- ------------------ - -------------------- ------------------------------------------------ ------- <br /> FINAL INSPECTION BY:.......... -� ------------- Date-----------------.F <br /> ----------- --------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Nazellon Ave, 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,Callfornia Lodi,California Manteca, California Tracy,California <br />