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FOR OFFICE USE: e �; <br /> a ? ,.e <br /> y1--- APPLICATION FOR SANITATION PERMIT Permit No. .a2�J w <br /> ' (Complete in Duplicate) <br /> _-------- This Permit Ex i-res 1 Year From Date Issued Date Issued.,_ ..-_�T � <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I <br /> This application is made in compliance with County. Ordinance No. S49. ' <br /> ;. 3 <br /> JOB ADDRESS AND LO TION-.._-- ---. �'/TJ � � _ <br /> Owner's Name --fir Phone - -- --`---fie .. <br /> --•---- <br /> Address �`•X_- l -- -----------------------------•----•-•------------------------------._-••--------•----------------..... <br /> -wi <br /> etor's Name `!r' - ---=------- Phon,._' _'t-------.-'�__-'� ' <br /> Installs ► - ---- ----------------------'-------------,,---:--------------------- � - ❑ . � <br /> Contra <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ` Motel Other <br /> Number of living units..._Number of bedrooms/ __ Number of baths . ._ Lot size _..- .. tel .. - ----------- <br /> _ /� <br /> Water Supply: Public,system,[]- -Community system'.❑ PrivateDd , Depth to Water Table _6a ft. <br /> Character of'.soil to a depth of 3 feet: Sanaa❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�U. Hardpan ❑ <br /> Previous Application:;Made: (if yes,date`.:.: • - ) No New Construction: YesY No ❑ FHA/VA: Yes ❑ No ❑ <br /> r5 '� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sepfic tank or,cesspool permitted. if public sewer is available within 200 feet.) <br /> ��. <br /> Septic Tank: :.Distance from nearest weN:.. Q....._.Distance from fo`ndation.. ..........:.IVIa#er al_ '+,-_.....-..---.........,._..rad L <br /> r . . r <br /> No. of compartments------...2-------------size--..�X �._ Liquid depth �_.__. __.-.._.Capacity... _. -. .. -.._ <br /> Disposal Field: 'Distance from nearest well Distance from foundation.. �6_ ......Distance to nearest lot line.-.��-..._, <br /> EX, 'Number of lines__.__._-/Q .'. _._. .._Length of each line i�E:=-..tea- _......Width of trench Z "� <br /> Type of filter material..-. ' e r - Depth of filter material_..�.� _length_..'._- ---------` .. ...... <br /> f. <br /> Seepage_Pi#: Distance to nearest well_,/0_5F-r.._..Distance from foundation---la-------..Distance to nearest lot Irne�'.� _---- Jf , <br /> lumber ofpits_.. <br /> 'J-_ti_:...-.Lining material---- IC Diameter----- 3�� Depth � --- ---- <br /> =----- <br /> tax M':, �. # , _ ;y <br /> Cesspool: Distance.,frorn nearest veli- .-.._--..:*.Distance from foundation------------------ Lining material -----,__ ----------- V/ <br /> ❑ Size Dii3meter' ----------Depth------------- ------------- - --- --------Liquid Capacity gals. <br /> Privy: Distance from nearest well------ ----.._-Distance from nearest building. .j. ? -.. .-. <br /> ❑ Distance to'nearest lot line.- - = - - { <br /> Remodeling and/or repairing (describe):------- --------- --------------- --------------------------------------------------------=------------------ ------------------------------- 1 t <br /> ---------------•-------------------= --•-------- ------------------------ ------------- .,. <br /> --------------------------------------------------------- ----------------- ---------- <br /> --------------------=----------------•-------------- ------------------------------------------------------- -----------------1--------------------------- ------------ } <br /> I hereby certify that I have prepared 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. 1 <br /> (Signed)------------------------------------------------------------------------- - ----------------------------------------------------- -- - - - - ----(Owner and/or Contractor) <br /> ' <br /> By: ----- _----------- --- - - ----- Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> y <br /> FOR DEPARTMENT USE ONLY <br /> l e.: , <br /> APPLICATION ACCEPTED BY------------ .........` `"` - :r�.---------------------------------- DATE----- ,�i � �� --------------- <br /> REVIEWEDBY------------------------------------------------------------ ---- ---------- - -----------------------------------------•--• DATE--------------------------------------------------------- <br /> BUILDING PERMIT ISSUED-------------------------------------- < = ----- -------------------------- <br /> ------------------------------ DATE-------------------------------- -r-�--- <br /> --- <br /> tio s: Z'` i . _r- ------ - --------Alterations and/or recom�enda . G <br /> l ------------------------------ <br /> ---------- <br /> ---P- - 1 --------- ------------- <br /> ---•-•----------------•------------------------...------------------•--------------------------------------------------------- ----------- -------------- ------------- ------------- ------ ---------------- <br />.y f <br /> FINAL INSPECTION BY:. ----- .. Date....- - -- <br /> SAN JOAQUIN"'LOCAL HEALTH DISTRICT <br /> 1601 E.Harellon Aro. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Lodi, California Manteca,California <br /> Tracy,California <br /> Stockton,California y, <br /> F.Rco. <br /> F` � �j <br />