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FOR OFFICE USE: qg/� <br /> ------------------------- ------- ------------ — �d✓'7 <br /> ---� APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ------------------------------------------- <br /> -------------- <br /> --------------- <br /> (Complete in Duplicate) Date Issued <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 work herein described. <br /> This application is made in compliance with County Ordinance No. 549. ' ,(rj4 <br /> �( /s L <br /> JOB ADDRESS AND LOCATION 'F�67, d o �'� ��:_L/�/�1� � --- - - �-��- - - Zy" <br /> Owner's Name------ l; �� ------=1 - S _ —------------ <br /> ----- ----------------------------- ------- <br /> Address---------- <br /> -----Address-----...__ -i`l� -­­-------------------------------•-------------.. <br /> It — <br /> Contractor's Name__ 4�! Phone_______________ ____.. <br /> -------------------------------------------------------------------------------------- -- <br /> ----•--------------- ------ <br /> Installation will serve: Residence F1Apartment House ❑ Commercial ❑ Trailer Court [IMotel ❑ — <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size __x__3Gt ---------------____________ <br /> Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table,2.57 ft. <br /> Character of sail to a depth of 3 feet: Sand Gravel ❑ Sandy Loam El � Clay Loam [I' Clay ElAdobe E] Hardpan C] <br /> Previous Application Made: (If yes,date--------- ----------� No�] New Construction: Yes No [:] FHA/VA: Yes E] No E]M <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: n <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet <br /> i <br /> Septic Tank: Distance from nearest well-__ _Distance from faundafion_ Q.__.__-_____.Material-- e.(.v.PE` j <br /> No. of compartments___ ----------------Size__ X5-__,Y�X_-__Liquid depth__ _-.-_----------- <br /> /' <br /> Distance to nearest lot ine__ __..____ <br /> Disposal Field: Distance from nearest well 5Z)------Distance from foundation__/_-.-._ f/J <br /> Number of lines----- ---------------------------Length of each $ine_.____ d------/i--------Width of trench.-_A 110,----------------_--_-- �I <br /> Type of filter material_AN1�l�_.-_Depth of filter materiaL_. _$�_.________Total length------- ____.__.______---_____.___. <br /> Seepage Pit: Distance to nearest well----------- ----------Distance from foundation___________________Distance to nearest lot line._______--_._____ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth/------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----------------_Lining material__.-.-._---____----.___..______-____. <br /> ❑ Size: Diameter-- ------------------ ----------------Depth-.--------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest wel------------------------------------ Distance from nearest buJclin-- 9------•--- ----------------------- <br /> n -------------------❑ Distance to nearest lot line----- ------------ ------------------------------------------- --------------{-------------------------...... <br /> Remodeling and/or repairing (describe):_„�0 ------ r - ' ---- _/------_ <br /> --------------0---------------------------- - --------------------------------------------------- <br /> ---------------------------------------------------------------------------•-•-----------------------------------------------------------------------•----- ---- <br /> ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -- <br /> I hereby certify that010 prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State s, re ulations of +he San Joaquin Local Health District. <br /> t <br /> (Signed)-/--------------- -A--------=-----^��- --- ----- <br /> t ------------ <br /> (Owner and/or Contractor( <br /> --------------------------------------Title----------------- - -- --------- ----------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> POR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- - - - - ---------------------------------------•--------- QATE :_ r <br /> REVIEWED BY------------------ ------- ------ ----- ------------------------------------------ DATE-P- <br /> ---- ------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------- ------------•------ --------------------- ---------- DATE-----------•--•------------ -- ------------------------------ <br /> Alterations and/or recommendations:-- .------------ ----•-----------------•------------------------------------------------------------------- ------ <br /> ­ <br /> ---------- ----------------------------- ---------------------------------------------------------------------- ------------------------------------- <br /> ------- --------- --- -- -------- ---------------------- ------------------------------------------ -- <br /> -------------------- <br /> - <br /> 'l l- &rO <br /> DateFINAL INSPECTION BY:_. SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.0 C. ` <br />