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FOR OFFICE USE: <br /> ----------------- -- --------------------- -- - - <br /> APPLICATION FOR SANITATION PERMIT Permit No. .7 .......`........ <br /> ------------------ ----- --------- <br /> (Complete-in Duplicate) fo -15-77 <br /> __ _____ --------------- This Permit Expires 1 Year From Date Issued Date Issued _______________________ <br /> Application is hereby made to the San Joaquin Local H lth District for a permit to construct and install the work herein described. <br /> This application i's made in compliance with County Ordin ce No. 549. <br /> J 0 J`V_4 L.� , <br /> JOB ADDRESS LOCATION------ FK -... T. .� �--- - � �"" <br /> I Owner's Name .'~___�- --- „ ._ ._L�------- --- -- ------- 4 ----- ------------ <br /> Address <br /> -----. Phone_ <br /> ` ` c ------ ------ ► m ` ------ -------- <br /> ----------------- <br /> --..._ ' .-E._ __ <br /> Address------•.�-•-••--- -�------- ---- --------�---- --- .----------- -A� ( ¢, ► '_ - Phone-- <br /> Contractor's Name---- A6--- � <br /> I Installation will serve: Residence PfNApartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ <br /> I a � . <br /> 1E Number of living units: -- ----- Number of bedrooms r Number of baths_1...._ Lot size _.... _l=� b!!' - --------------- <br /> I Water Supply: Public system ❑ Community system ❑ Private Ix Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan .tel <br /> j Previous Application Made: (If yes,date------------------- ) NOX New Construction: Ye SIN No ❑ FMA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer <br /> wer is available within 200 feet.) r f <br /> Se54c <br /> Tank: Distance from nearest well--- ----Distance from foundation---- _- .Material ..... . <br /> No. of compartments____-�....-...r Size-------------------- -----------Liquid depth--------- -. _--- ...Capacity---�.��� `! <br /> Distance from foundat' n __.. <br /> Disposal Field: Distance from neare, t well..�X.._ ��.__ ..Distance to nearest lo; line_ __' � <br />'I Number of lines----- _._� .. Length of each line_- ---.-.Width of trench._ ` ...___ <br /> Type of filter material---- <br /> Seepage <br /> aterial.___.-_ Depth of filter material---- . .__-_�-...Total length______-�.___.._____ _ <br /> i` ff,, //,,ma�j�yy <br /> r Seepa a Pit: Distance to neare t well..__Vx49......Distance from if nda ion__619-------- Distance to nearest lot line-� �J a <br /> f ' <br /> Number of pits.__ _.______.__Lining material _.��.. Diameter._,�r--__.___.Depth_. ~... f.. <br /> Cesspool: Distance from nearest well ----------------Distance from foundation--------------- ..Lining material-------------------------------------- 1 <br /> F] Size: Diameter- ---- ----- ---------------Depth---------------------- - - --------------Liquid Capacity.-- ------------------------gals. l� <br /> Privy: Distance from nearest well------------------------------------ --_._-._Distance from nearest building-.-.--_--..--_.._______-_-_------....-.. <br /> ❑ Distance to nearest lot line --------- ------ ------------------------------------------------------------- ------------------------------------------------------------ <br /> Remodelingand/or repairing (describe)-.................. '----------------------------------- ----------------------------------------- -------------- ------------------------•--- <br /> --------- ------------•---- ------------------ ---------- --------------------------•------------------ ---------------------------------------------------------- ------------------- ------------------------------------ 0F <br /> ------------------------------------------------------------------------------•---------------------------•---------------------------------------------------------•------------------•_------------------•----------------- <br /> - -------------;--------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------r----------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> j ordinances, State laws, and rules and regulations o San Joaquin Local Health District. <br /> t <br /> (Signed} 9-._. . _y _ (Owner and/or <br /> _- °r) ter. <br /> r wner a Contract <br /> - ._ ,r_._._ _ - Title _ —,.. <br /> tseii lot location of s stem in relation to wells, buildin s, etc., can be. lace `on reverse side].(Plot plan, sho y 9 P <br /> FOR DEPARTMENT USE ONLY ll <br /> w f <br /> APPLICATION ACCEPTED B � -------------------------------------- ----- DATE----��' �-- <br /> REVIEWEDBY------------------ --- ----------------- -------------------------------- - - - ----------------------- DATE--- -------------------------------- - i <br /> iBUILDING PERMIT ISSUED-------- ------------------------ - ------------------------- ----------------- --------------....... DATE------------------------------ -- ------------ <br /> Alterations and/or recommendations------- -- ------ -------- -------------------------------------------------------••-- -----------------•--------------------------- <br /> ----------•--- ----- --- ------------------------- ------ ------- -----------------­­-------------­------------------------ - ------------------------ -------------- -----------------•---------- <br /> ------------- -------------- ----- ----- ----- --------- --------- -- -- ----------------------------------- --- ------------------ ----------------------------------- --- ----- -- - ----- -------------------------- <br /> FINAL INSPECTION BY:. Date &-.a . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />