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FOR OFFICE USE: <br /> G-------- <br /> APPLICATION FOR S <br /> ANITATION PERMIT Permit No. <br /> ------------I-- -------------------------------- (Complete in Duplicate) <br /> Date Issued <br /> --------------------------- This Permit Expires 1 Year From Date Issued <br /> Appli.cafion 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 <br /> JOB ADDRESS AND LOCATION------I9 (!�-p � ---------- uhf---•------------------------------ <br /> Owner's Name------"�,*7s----/� lC/1 ------•----------------- ----------------------------- ----- Phone------------------------------------ <br /> Address--------------J710f 0...C.!ee v; a '-------------•------------------------ ------------------- <br /> Contractor`s Name............ ------• ------------ ---------------- -------------------------------------------- Phone--------------------------•---- <br /> Installation will serve: Residence R--'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/__ Number of bedrooms ___ Number of baths _ _,_ Lot size +r--t'1"-'-K=-_-1/1)-247-------------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table '10a.ft. <br /> 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 g!New Construction: Yes ❑ No 'FHA/VA: Yes ❑ No ®— <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 well-----------------Distance from foundation--------------------Material------------------------ -----­--------------_ <br /> f$�G4e No. of compartments--------------------- ----Size---------------•----------------Liquid depth-------------------------.Capacity----------------------- <br /> Disposat Field: Distance from nearest well-----'---Distance from foundation-___-._ ._ � � <br /> __ ._.Distance to nearest lot line___�_df_+_ . <br /> Number of lines--------- _._-- Length of each line____ 7 Width of trench-,O----------------------------- <br /> Type of filter material/ �A*,Depth of filter material_-._,;�1�__.._.__Total length---. ------------------------.__ �r <br /> Seepage Pit: Distance to nearest well......_`----------.---Distance fro foundation_-,�_Q------.Distao e to nearest lot �.___________ <br /> Number of pits...._------------Lining material -�C -Size: Diameter__.�.�-----------Depth:2> _._ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.,.--------------..Lining material__._..._____.________.___.________. <br /> ❑ Size: Diameter---------------------- ----- .. ---_..Depth----------------------------- - - - ----------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well____----------__---------------------------------Distance from neares+ building--------------.-______-_______.._...__._. <br /> ❑ Distance to nearest lot line---------------------------- --- ----- ------------------------- ------- ------------------------------------------------------- -- <br /> r ---- -------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):---------- <br /> ' — <br /> ------------------------------------ ------------------•--------------•--------••-•------------•------------------------------------------•-------•------------;------- ----------------------- ---------- --•--- <br /> ------------------------------------ - <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 /> ordinances, State laws, and rules and guI tions of the San Joaquin Local Health District. i <br /> (Signed)--------------------------------------- --- -----(Owner and/or Contractor) <br /> By:------------------------------------------------- {Ti+le) -...... <br /> (Plot plan, showing size of lot, location of system in tion to wells, buildings, efc., can be placed on reverse side). <br /> DEPARTMENT USE ONLY p <br /> APPLICATION ACCEPTED BY----------------- ---- ---------------------------------------- DATE.......... <br /> -----. �-- �"�� i(--- <br /> REVIEWEDBY---- ---------------------------------- - .------ -- - ---------------- --------------------------- ------------------ DATE------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------ ------ --------------------•---------- --•---------------------------- --------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations--------------- --- ------ ---- ------ -- - -----------------------------------------------•- -----•---------------------------- --------- -•------------- <br /> ----------------------------------------------------•-------------------------------------------------- ----------------------------------------------------- --------I----------------------- ------------------------------- <br /> -----•-------------------------------------------------------------------------- - ---- -- - --------- ----------------------------------------------- --- - ---------------------­ - - ------- --------------------- <br /> �> �� <br /> FINAL INSPECTION BY:____C_�....... _. fi _____________ Date------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California d ; Lodi,California Manteca,California Tracy,California <br /> F.P.EO. <br />