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FOR OFFICE USE: <br /> ------------------------�, ------ ---------- ------- <br /> APPLICATION FOR SANITATION PERMIT Permit No.-1212-3.�� <br /> - - --------------------------- -- ------ - <br /> ----- -- --------------------- - --------- (Complete-in Duplicate) <br />' - ----------- --- This Permit Expires 1 Year From Date Issued 0111%� 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. A-1A) t O(q— 2-�O ®7 <br /> -rt <br /> Z2-3 S3 &) - Cc c a 7_1K_ <br /> JOB ADDRESS AND LOCATIO ��-&V 'l-- , ------------ •.. , <br /> i Owner's Name __ ------------------------------ <br /> ------ Phone------------------------------------ <br /> Address------------ ----------------------------------------------ev-14,"111'-A11,�--------------------------------------------- ------------------------------------------ <br /> -Name -- ^` -.--.---.•� - -�../. .1- ,�./ �-- n <br /> e <br /> Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ fAotel ❑ Other ❑ <br /> Number of living units: ---- Number of bedrooms ..--- Number of baths'y___ Lot size e � -------- -------------------------------- <br /> Water Supply: Public system ❑ Community system ElPrivate {1] Depth to Water Table _ ft (�? <br /> Character of soil to a depth of 3 feet' Sand ❑ Gravel-`❑ Sandy Loam ❑ Clay Loam po Clay ❑ Adobe ❑ Hardpan ].' <br /> Previous Application Made: (If yes,date-----------_...... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [:1 <br /> w <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 weIV 4'.___-_Distan from foundation--/r1h'.-._.-_Material �'�' --------------------------- <br /> 4J No. of compartments...,.......------- -...Size '<' � a- _ fi' uid depth..--- _'_-- ------ _Capacity-46ra-V-------- <br /> Disposal Field: Distance from nearest well/$_0--.-...-Distance from foundation./----_-._-.Distance to nearest lot line-S'--4------- <br /> Number of lines____..---- Length of each line----------------------Width of trench_.�-_�.-`----..._._-_--__._-_- <br /> .__.--------Depth of filter materia!__- �Y"---___-._Total length_ -_ '__________________________ <br /> Type of filter materiax. <br /> i <br /> Seepage Pit: Distance to nearest well,t"__'---------Distance from undationZro.----.._.Distance to nearest lot liner--t------ <br /> ] Number ofits__ Lining material , _ ._-_---_.___ Size: Diameter...3j-------------Depth-OX.,S'"__-----.--____--_- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation------------ _Lining material-.-.-----._-----..-..-.------------_. <br /> ❑ Size: Diameter- -- ----•--------- ----- - --.--.Depth-%------------------ --------------Liquid Capacity-------------- -------------gals. <br /> i Privy: Distance from nearest well-----------------_---..__.__._..--------------_Distance from nearest building-____-_____-_.____--_----------...___-- <br /> ❑ Distance to nearest lot line --------------- ------------------------------------ ------------------------------- ------------------=---------------------------- <br /> Remodelingand/or repairing (describe)--- ----- -------------------------- -----------------•---------•-------------------------------­­----- --------------•-------------------------------- <br /> - ---------- - - - - <br /> ---------------- --------------------------------------- -------------------------- ------- ------------------------------------------------------------ --------------------------------------- --------------- <br /> ------- ---- ----- ------------- ------------- ------------------------ -------------•------•------------------------------------------------ -------------------------------------------------------- <br /> I <br /> -- -- --- <br /> I e e6y certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinan s, a laws, an4 rules nd regulations of the San Joaquin Local Health District. <br /> (Signe .. -- -- - - -------- ---------- ----- ------------------------------------------------- - ----- --------------------(Owner and/or Contractor ..� <br /> By: �- (T7141 el 7�= ................................... <br /> (PI plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse sider <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- - - - - - -- -- ---------------------------------- --- ---------- - - DATE---J "' '-47---- ------ -- -- <br /> REVIEWED BY---------------------------------------------------------------- -- --------------------- -------- --------------------- DATE----- ------- ----- -- <br /> -------- --------- ---------­-----4 <br /> BUILDINGPERMIT ISSUED-------- -- ----- ------------------------------------ ---------------------------------------------- DATE---------------------------------- - ------------------------- <br /> Alterationsand/or recommendations:----------------- ------ ------- -------------------------------------------- --------------- -------------------------------- a--------------------- <br /> ------------------------•-------------....-...------------------------------ ----- <br /> -----------_------------------------------------------------------ - -•-- --------------------- ----- ----- ----------------- ------------------ ------------ ------ ----------- ------•------------------------ <br /> FINAL INSPECTION BY: �'� Date— l'! - <br /> k <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hacelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California - Manteca, California 'Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> l <br />