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FOR OFFICE USE: - <br /> --- ------- <br /> _- _ _..___. _. APPLICATION FOR SANITA-TION•PERMIT Permit No. _l' :3�....... <br /> ------- -------------------------------- --------- '(Complete-in Duplicate) <br /> _------------ This Permit Expires 1 Year From Date Issued Date Issued �L-ice.----- <br /> ` Application is hereby made to the San Joaquin Local Health District for a permit to construct and inffall the work herein described. <br /> This application is made in compliance with County Ordinan q 549. <br /> JOB ADDRESS AtIg L CATIO -------f/--- --- -------- E --------1 -_'r <br /> Owner's Name..-.- �y <br /> E hone <br /> Address-------------------------d---- -•------• ---- r/`-",• � - �/_� <br /> Contractors Name - - --._.. Phone 4f---- D . <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> r <br /> Number of living units: . ..... Number of bedrooms le" Number of baths_.1.._ Lot size _.� - - _�- ...-._.-_-.-._-_--------- <br /> Water Supply: Public system " ( Community system ❑ Private Ej Depth to Water Table 2Sft <br /> J Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No [ New Construction: Yes ❑ No FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: . <br /> l (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) <br /> i IF <br /> Septic Tank: Distance from nearest well. (>VE Distance from foundation__ .---- ---Material --- _ ___.-.___ <br /> No. of compartments. ..-_..__ 1.Size-IX..3.X .�i7-- .Liquid depth..�_._Z_'".. .-_--_Capacity---TP_ j <br /> Disposal Field: Distance from nearest well...---.----__-Distance from foundation-_----------------Distance to nearest lot line_-.-------....__- <br /> ❑G7CLST,— Number of lines ------------------------ ---------Length of each line-- -------------.-------------Width of trench----------------------------------- <br /> Type of filter materiai--.--___---_---._-._--Depth of filter material_------- ----------..Total length---------------.__..___.-----.-.- --.-- <br /> i, F Seepage Pit: Distance'to nearest well......................Distance from foundation------------------- Distance to nearest lot line......--____--.-_ <br /> ❑ �)0.577_ Number ofits... ------------------ <br /> PLining material--------------- Size: Diameter--- -------- - -----Depth--------------------------------- <br /> Cesspool; <br /> ----------- - -- ----------•Cesspool; Distance from nearest well --------- ----- from foundation____ ........... ..Lining material-------------------.--..____---------- <br /> h ❑ Size. Diameter- -- --------- - - - ----------------Depth-------------- - -----------------------------------Liquid Capacity---------- -----------------gals. <br /> Privy: Distance from nearest well............... -------.--------------Distance from nearest building_....---______--------------------------. <br /> ❑ Distance to nearest lot line ----- ------------ - - <br /> Remodeling and/or repairing (describe):-.----------- - ------- -- ----�__F-•-- <br /> ----------------------------------------------------- <br /> ----------------------------------- <br /> ---- -- ---- ----- - -------------- - - ------------------- <br /> ---------- -------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ <br /> 1 hereby certify that 1;have prepared this a plication and that t work will be done in accordance with San Joaquin County <br /> ordinances, State laws, a es and regulatio of the San Joaqu' ocl Health District. <br /> (Signed)•------------- -- -- ------ - <br /> (Owne and/or Contract <br /> By: =-- --------- - Tltle r a o or <br /> ------------ --- <br /> (Plot plan, showing size of lit, location of system in relation to wells, buildings, etc., can be pla d on reverse side). <br /> FOR DEPARTMENT USE ONLY <br />. q <br /> APPLICATION ACCEPTED By DATE--------- 7 -- `69 <br /> REVIEWEDBY--------------------------------------------- ------------------------------ - ---------------------------------------------- <br /> DATE------------------ ---------- ----------------------------- <br /> BUILDING PERMIT ISSUED-------- -- -------------------------- --- •------------------------------------- ----------------- DA-TE---------------------- <br /> Alterations and/or recommendations--- ---- ----------------------------- ---- --- ----------------------------------------------------------------------------------------- <br /> I •------------ ------- --------------------------------------------- - ------------- ----------- ----- -------------------------- ---------- -- -- --------- -------------- ----------- ------------------------------------- <br /> -------------- ---------- -•---------- -- ----------------------------------------------- _­___./----------------------------------------------------- -----------.------------------------------ -----•--- <br /> -------------------- ---- --------- - ---------- <br /> - ---- ---- - --------------------------------- --- --- --------------------- --------- -- ------------------------------- --- ------- ------------------------ ----------------------------------------- <br /> FINAL INSPECTION BY:... Date <br /> ----------------------- 4� t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street1 <br /> 40.5 West 9th Street <br /> Stockton,California Lodi. California Manteear California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> I <br />