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FOR OFFICE USE: r <br /> ......................-.._-�-_�-� _-_._._---- APPLICATION FOR SANITATION PERMIT Permit No. •- ��'. g.� <br /> (Complete-in Duplicate) <br /> = ..6. 1 <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> fl L9 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> P t�This application,is made in compliance with County Ordinance No. 549. may_ j � <br /> JOB ADDRESS AND LOCATIONe-------�� �- ----`--- <br /> f / •----------------------------•------------ -- ------- <br /> Owner's Name-- 5.,�- "t. `/ .1 /.{iJ — ....._ Phone 7�. .. <br /> aa <br /> Address_,- <br /> ----- <br /> � ' <br /> . - --- - --- ------- -----------•^-•--- <br /> --------------------- <br /> f <br /> a <br /> Contractor's Name---- v - ----- - - --------- - -- <br /> Phone / - <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other [2--- <br /> Number of living units: .. ----- Number of bedrooms -------- Number of baths--------- Lot size ---4.5Z.. <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .l ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--lHardpan ❑ <br /> Previous Application Made: (If yes,date-------------- 1 No ❑ New Construction: Yes PRI"'No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200feet.) <br /> Septic Tank: Distance from nearest well-0740..._.Distance from foundation-_. v'---..Material <br /> No, of compartments .Ca acit <br /> P ------�>- -......--Size_.���`-}�--�------Liquid depth----� ----- - ----- p Y/�-0---_---- <br /> Disposal Field: Distance from nearest well_,_-. <br /> Vi I <br /> ,.. <br /> ------Distance from foundation.�.4..-...____Distance to nearest lot line--4q.._ <br /> Number of lines ._.._-�----_.... Length of each line_ -.�Q-----------------Width of trench_.__. -__ <br /> �- ------;------- <br /> Type of filter material..-5-o C_ I'�--Depth of filter material_....��--........Total length------------------a7 4---_---.- , <br /> Seepage Pit: Distance to nearest well----------------g----Distance from foundation___._----.._.__....Distance to nearest lot line----------.------ <br /> Number of its.-- ------------- ----Linin material--------------------- Size: Diameter------------------- Depth' <br /> epth'.------------------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------. _ Lining material....-- ------------------- I <br /> ❑ Size: Diameter- -- -------- ----- --- -----Depth--------- ---------------- Liquid Capacity-- gals. <br /> Privy: - Distance from nearest well------------- Distance from nearest building__............. <br /> ❑ Distance to nearest lot line - <br /> --------- <br /> ----------------- <br /> Remodeling and/or repairing (describe):_-------. <br /> --••-- - '--•----- ------ ------- -�--------------'--'--------•------------------------------------------------------- - <br /> -t <br /> 1 <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 <br /> ///agand regulations of the San Joanuin Local Health District. <br /> k <br /> (Signed)---- ---- ���..�- -- ---•--- ----:--- ^"�. . ------ ------ - ---( caner and/or Contractor) � <br /> By-------------------------------------- ------ <br /> __4`"" Title <br /> (Plot plan, showing size of lot, location of system in relation to welt;', buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- ►rw <br /> C,� ----- ------- --------- ------- ----------------�--- --------- DATE------------- ------- -REVIEWED --- - <br /> REVIEWEDBY --------- ._----------- -------------------------- - ------------------------------------ DATE-- <br /> BUILDING PERMIT ISSUED-----•-- --------- ------------ ----------e --------------- ------------------.--- DATE.- ----- <br /> Alterations and/or recommendations:_...-.- -_ ` ----_, <br /> ----------- - -------------------------------------- -------- ----- --- <br /> --------------------- <br /> ------- - -------------- -- ------------------------------- --- --------------------- ------------------------------------------------------------------ ---------------------------- <br /> ------------------------ + <br /> ------------ ---------- ---­ - . ------------ ---.---- - - --------- ----------- --- --------. ------------- ------------------------------------------ --- ------- ------------ ---------------- -- l <br /> FINAL INSPECTION BY:--- 5- tc) - ,O <br /> ------- ----------- Date .------- --------- ..�------------------- -------------------- a <br /> w <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT t <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.92M 1-67 Vanguard Press f <br /> i <br />