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_ff FOR OFFICE USE: <br /> -------------- ------------------ -- l <br /> APPLICATION FOR SANITATION PERMIT Permit No. __✓�__ <br /> -------- -- -------------------------- -- --------------- (Complete in Duplicate) � // <br /> Date issued _V//Ar <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. <br /> JOB ADDRESS AND CATION---- ---- --------------------- <br /> Owner's <br /> --------------Owner's Name-- -- -------- --c��+7, - - Phone----------------------------------- <br /> Address--- <br /> -- ------------------•-•-------- <br /> Address--- - ---- ------------------------------------------------------------------------------------------ <br /> Contractor's Name---- s�----------------------------------------- -------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence ®'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -7---- Number of bedrooms ��Z--- Number of baths _/`Z__ Lot size ---------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _ 4-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 �New Construction: Yes �No [&1HA/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 /> Sept c Tank: Distance from nearest well 6� _ Distance from foundation- /Q----- --Matesial--&- �f ------ <br /> No, of coin artments____ r_j - �Size_s � _ 1740- Liquid de th___��� Ca acit <br /> p T� G P. ---V------------- P Y <br /> ^� <br /> DiIso a ieldi Distance from nearest well- Distance from foundation_ <br /> .l�______._.Distance to nearest lot line______ ________ A <br /> , 'l.C�e/ Number of lines___.___-- -._.- -._ ___ ength of each line-- � y Width of trent <br /> [��C Type of filter material-i/ � Depth of filter material Total length - - � <br /> f <br /> Seepage Pit: Distance to nearest well__-_ / --_-_[}istance fr fou dation__ <br /> _-___ Distance to nearest lot line__!! ----7 <br /> Number of pits------/.r------------Lining material -size: Diameter- __ --- Dept h— <br /> --- <br /> �- <br /> Cesspool: Distance from nearest well--___..-_----._.Distance from foundation"-`"i-------------- Lining material--------"------- _-------- <br /> ❑ Size: Diameter-----------------------': --------- <br /> Dept h----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____.._________________--._____._._. <br /> ❑ Distance to nearest ]of line---------------------------------- - ------------------------------------------------------------------- ------ <br /> Remodeling and/or repairing {describe):--------- ---- -L.-.- -- - - --- ------ - ------- <br /> ----------- <br /> ----------- <br /> ---- <br /> ----------- ----------- --- -- --------------- <br /> -. 40 <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, o.nd rul s and regulations of the San Joaquin Local Health District, s <br /> {Si ned ­_16-1 <br /> g - -Contractor) <br /> By:----------------------------------------------------- ----------=------------- ----- Y {Title) �K L <br /> (Plot plan, showing size of lot, location of system in relation ells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- ___ s ��/6✓-�..-_-------- <br /> '------- DATE / <br /> REVIEWEDBY--------------------------------------------- --------------------------- - ------------------------------ ------------------ DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------- ------------------------_­----- ------------------------- DATE---------------------------i --------------- -------------- <br /> P ,. <br /> Alterations and/or ret mmendation ? - � <br /> - - - --- Si ._------ tiz�_�- �_ -`- -- =-- =s"--- <br /> - -- ---- - �• � <br /> -------------------------------------- ---------------------------------- ---_--- --- <br /> r ' <br /> ----------------------------------------------- ---------------------------------------------------- --- -------•------------------------------------------------- ------------------------------------------------- <br /> ----------------------------- - ------------ ------- ----------------------------------------------- ------- -"--- --------------------------- --- ---------- -- -- ----- <br /> , <br /> s <br /> ------------- -------------------- •-------------------------- ---------------------------------------- ------ ------- ----------------:-- .- <br /> r / f <br /> FINAL INSPECTION BY:.----- -. ��y� Date-------- -------- - -- / �� <br /> SAN OAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:etton Ave. 300 We t Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lod- California Manteca,California Tracy,California. <br />. r.P.co. <br />