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FOR OFFICE USE: <br /> -------------------- <br /> " _._____________________________ ------- .___:_.__. APPLICATION FOR SANITATION PERMIT Permit No. .. a:.�........ <br /> ------------ ----------------------------------- (Complete in Duplicate) /a <br /> -----------------------------------•�------ This Permit Expires 1 Year From Date IssLi`ed .___- -/ <br /> Date Issued _-� <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application is made incompliance with County Ordinance No. 549. _4 <br /> JOB ADDRESS AND LOCATI N -------------------------- ----- �J /l1. �2E= <br /> t <br /> _e I <br /> i <br /> Owner's Name--------------------- <br /> Address � Pone <br /> e-------------••--- -------- -----------------------------------------------I--­--------­---------­­.............. ....... <br /> •--,- <br /> ------ <br /> • ...---••--•---- � - -- ---------f-Contractor's Name----------------------------- <br /> --------------------••------ Phone----------------------------------- <br /> Installation <br /> .----....----•---•----•--- <br /> Installation will serve: Residence Apartment House Commercial ❑1 Trailer Court❑ Motel ❑ Other ❑ <br /> Number of living units: ____l_ Number of bedrooms _Z Number of baths _____ yLot size ________175__/_X___ c� _ _ <br /> ► # r ) ► <br /> Water Supply: Public system ❑ Commuriity system [IPrivate W Depth to Water Table ft.- - <br /> Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑. Sandy Loam ❑' Clay Loam.)] Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Madel (If yes,date:--------------------) No P§ New Construction. 'Yes No ❑ FHA/VA: Yes ❑ No,R' <br /> TYPE OF INSTALLATION ',AND SP�CIFICATIdNS:_ y: <br /> ,(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r 6. I y i <br /> I Septic Tank: Distance from nearest wtiel __�J.Q-- tVVVistancerfrom undation____/L�_•_ ___0%terial_- __:______. _=a.-_________.._____- <br /> No.,of,'compartments Size... X---��----;>� :rLiquid dept);----�------ Capacity- <br /> Disposal Field: Distance frorn.neaFesf well: - . __._.Distance from fo,��ndation____P D Distance to nearest lot fine_______ <br /> [ Number of lines-------------�--------- Length of each 1 '_-'�------- - --.Width of trench-------��•------------._. <br /> Aistaini <br /> e f filter mater; o ____Depth of filter material____-I __---_ .._.Total length_______-___-•-�.�--Q__�__________ ____YP '.Seepage Pit: ce +o nearest well_.-. Q___ _____Distance from oundation_ ..f � � nearest lot�ine_ __________ <br /> � :. ,, 5 t <br /> Nymber of pits________/__________Lining material__-�.0 . r; :Size: Diameter.__________ Depth_._______________________ <br /> ❑ p Illation ---- = Lining matenal <br /> Cess ool: xri Size:Diameter.nearest wall-----------------Depta�nce from fou --------- ---�-----_--Liquid..Capacity----------------------------gals. <br /> Privy:;-' j , " i Distance - <br /> from nearest well------------------------------------------------Distance from nearest building---------------------------------------- <br /> ❑ E tr i : <br /> -� - <br /> I � , Distance to nearest loft line-------- ---•------------------------------------I------------------------•----------•----------------a------------ �_....-------------------- <br /> Remodelingand/or .repairing (describe)---------------------- ------------------------------•-----•--------------------------••--------------------------------------------------4........ <br /> ... <br /> �?� :ter <br /> E --------------------•---1---------------------,----------•---`------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------'---------------------------------- �------- ------------------ <br /> I hereby 'certify that I(have prepared•-#lis 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 /> F r linre <br /> ��(Signed)---' ----- - -- - -------••--------------------------------------"--------(Owner and/or Contractor) <br /> B :--•-^= -------------------`--- . - Ti+leY ----- ( )---------------------------------------- - - <br /> (Plo+ plan, showing size of lotIotation of systemtion to wells', buildings, etc., can be placed on reverse side]. <br /> { '"'-1 FOR DEPARTMENT USE ONLY <br /> APPLICATION .ACCE=PTED, BY---- - -- - --- -- --------------------------------------- DATE.....4 r( Q------- --------- <br /> i REVIEWED BY--'-A=------ ' --------- - <br /> - ------------ ------------ ---•------------------------------------------------------ DATE..------------------....--------------------------'--- ---- <br /> BUILDINGPERMIT ISSUED"'J '%----•-------•--------- --------- --------------•------------------------------------------ DATE-----------•----•--------------------------------•----------- <br /> Alterations and/or, recommendations:-----------•---------------- ------- ------•--------------------•- ------------- -----------•-------------- <br /> '--- ':,k'----=-------------- <br /> ---17 ::- �`--------------------------•--- Vit-..- 11 Mr►�4F� (+.. -� <br /> i. <br /> rr _ <br /> I =- ` ----------- ------------------------------------------------•---•------•--------------------------------------------------•------------------------------------ ------- <br /> - <br /> - ---------• •- --- ---------- Date------- I z=- <br /> FINAL INSPECTION BY :_.-------- ---_-...- _ - ---------------------- -- <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 M6nteco,California Tracyr California <br /> L <br /> Er-9 REVISED 6.59 F.P.DD.2M 6.60 <br /> F <br />