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FOROFFICE_USl : <br /> -------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . -........................ <br /> — - ---- ---__------------------------------ (Complete in Duplicated 7� / <br /> Date Issued ._.�-�--- --6- <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo M;"ea. <br /> This application is made in compliance with County Ordinance No. 549. ,�J <br /> JOB ADDRESS AN CATIO --- ------ - - - ------1 <br /> OwnersName---- p`�p -- -- - ----------- ------------------------------ -------------- ---------------------------------- ------- Phone------------------------------------ j <br /> Address.......2'_ _z--¢__--. ! �- --------------------------•-----------•------------•---•----------------------------------------------------------------- <br /> Contractor's Name----- -- ---- - - -- ------ --- ------------- - --• .- Phone----------------------------------- <br /> Installation will serve: Residence „Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --/- Number of bedrooms -._ Number of baths -7- Lot size -__1lr ---'.-.-.--.__----.- r <br /> Water Supply: Public system ❑ Community system ❑ Private [[Depth to Water Table /$O"'ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ f <br /> Previous Application Made: [If yes,dote......... -,--------) No F New Construction: Yes ®/No ❑ FHA/VA: Yes PR--'No ❑ <br /> TYPE OF INSTALLATION AND-SPECIFICATIONS: _ - w _ � <br /> (No septic tank"or cesspool permitted if public sewer is available within 200 feet.) y°�p <br /> Septic Tank: DistanceJrom nearest well_-40--!--Distance from foundation--./>�---_____.Material-L-16 A r��-----------. <br /> �] - <br /> de th------ s -------Ca acit Z.K'<`�---.No. of com artments- _ . <br /> Disposal Field: Distance from -nearest well. .----_Distance from foundation- --..._---.Distance to nearest lot line--✓-----_---- <br /> r <br /> Number of lines�.�:-'2----/---�_._.-/.---Length of each line----�p�----___��_._.-.Width of trench.�-_.__�.-.-__..---_-_.-_. <br /> Type of filter matetiaL , {+ef_tr_---Depth of filter material---Is------._-.-Total length---���--------------------------9 <br /> Seepage Pit: ,wY Distance to nearest well____-._._---_________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ '"Number of,pits1------------------Lining material----------------------.Size: Diameter-----------------------Depth--------------------------------- <br /> 4 <br />•• Cesspool: Distance from nearest well-----------------Qistance from foundation.__.____: _._..Gning material-------------------------..._- � <br /> ❑ Size: Diameter---- - ------------------- -----------Depth---------------------------------------- <br /> - Liquid Capacity gals. <br /> Privy: Distance from nearest we]-----------------------------------------------_Distance from nearest building----------------------------------------- <br /> ❑ Distance to nearest lot line---------------------- -------------------------•---------------�------------------------------------------------------ -`. <br /> Remodeling and/or repairing (describe): °� '1 - -.= -'''�?tl- --------------=--------------•-----------••-----•-----------` <br /> ---------------------- ----•--------------------------------------------------------------- ----------------------- - �1 <br /> -------------------------------------------:---------------------- •--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> k, . <br /> ---- - --------------------------------------------------------------------------------------------------------------------------------------------------- - ----- ----- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with-San Joaquin County <br /> ordinance's, State law44­� <br /> nd rules and regulations of the San Joaquin Local Health Dis+rict. <br /> (Signed 7;e/le -- - ------------- ---- - ---------------------------------------- --(�r Contractor <br /> B -� (Title)- -------- - ` " .•� <br /> (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY • <br /> APPLICATION ACCEPTED SY--- =®' DATE ---- -------- ------------- <br /> REVIEWED BY- ------------------------------------------------- -------------------------.-------------------------------------------- DATE-------- -- ------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------- ------------ ------------------------------------------------------------------- DATE------------------------------------------------------------- . <br /> Alterationsand/or recommendations--------------- ------ -------------- ----------------•---------------------------------------•-------•-----------------------•- --------------------I------ <br /> k <br /> I <br /> t <br /> FINAL INSPECTIO BY: t. ---- -------------aDate.- - ---�._--�?�... <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 /> r.a.co. <br />