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FOR OFFICE USE: <br /> ; _:_3n----- APPLICATION FOR SANITATION PERMIT Permit No. <br /> -- ----------------- (Complete in Duplicate) <br /> - r Date Issued ___l9__�.�-_G <br /> �1_�ts This Permit Expires 1 Year From Date Issued <br /> Pp o is here, a e o 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 /> JOS ADDRESS ANND� /LOCATION-s'�y---��B'��t___!}�.. �'`� �-- � m�S___� _O S <br /> Owner's Name-----_; &4OI.-------1.+­ ev-----�---------------- ------------- - -- - - ------------------------------------- Phone------------------------------------ <br /> Address 1 �----- - ----- --- - --- -- ®'--- -- ---- -:1 <br /> (� <br /> Contractor's Name---------- - --------'.... •'- TZ� --------------------------------------------------------- ------------------------------ Phone----- ----------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> _Number of.living units: --I_.-.Number of bedrooms .--J_~Number of baths _ Lot,size .� 6-<�-: ------------------------------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'K�- Wardpan ❑ <br />' Previous Application Made: (If yes,date--- ­---------- No Ell" New Construction: Yes ER/No ❑ FHA/VA: Yes ❑ No-E}-' <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-�_6-_�-.-.----.MateriaL (j _- --------- <br /> ----------- <br /> �f " No.-"of compa'itments""" .---_---::::-.Size__: 4�X -�C9�Liguid depth------5.�----------Capacity____f an�- <br /> Disposal Field: Distance from nearest well.---- --------Distance from foundation-_� ------------Distance to nearest lot line---- --- <br /> Elm I Number of lines------- ------------ ---Length of each line--/ 07/0--"go--.Width of trench----------------------------------- <br /> Type of filter material_-- ,6-4,1C------Depth of filter material----IV..`------- Total length----- ----------------------- <br /> Seepage Pit: ►. Distance to nearest well......------------Distance from foundation__L6-----------Distance to,nea�est lot line__."~______.-_ <br /> ®/ Number of pits-------2---._-.---Lining material---__%��G_�t-Size: Qiameter._. ..r.-.___Depth_...-.- _s5`�!_____._.____ -- r <br /> 1 1 t <br /> Cesspool: s Distance from nearest well-----------------Distance from foundation---------_-_------..Lining material --._------.---.---.------------------ <br /> : -,7 <br /> -------.-- --.: .r Size: Diameter--------------------- -------.-Depth------ ----------------------- --------Liquid Capacity al$. <br /> Privy: 1 Distance from nearest well --------------------_--._.-_-_..-__-------------Distance from nearest Building__--------__-.---------------------------- , <br /> [] Distance to nearest lot lire------- ---------------0==-------------------------------- ------------------=-------------------------------------- ------------ S <br /> 1 <br /> Remodeling and/or repairing (describe)---- ------ ------------------------------ ------------------------------------------------------------------ -------------------------------------------- <br /> ----------- ---------------------------------•-------•---------- ---------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------- ------------------------------------------------------------------------------I---------------------------------------------------------------------------------------------------------- <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 regulations o he an Joaquin Local Health District. k <br /> (Signed)-------------------------------------------------- --= ------------ ---- •- --- ---- ------------ <br /> By: <br /> ----------�s = (�or Contractors } <br /> BY:----------`----------------------------------------------- ----- - - - -----------------------------------.------------------(Title)---------------- - - ------------------------------------------ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc., can be placed on reverse side). <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ - --' -----------------=----------- <br /> DATE---- ` 21G�1 _--------------------- <br /> REVIEWED BYi------- --------------- ------ ----------------- --------------------- ----------------- DATE----------------------------- ----...---- <br /> � . <br /> ® -BUILD1NGjPERMIT ISSUED------------------------ �-------------- ------- - ---------------------------------- DATE------------------------------- --------------------------- <br /> *o <br /> 'ons: -- - G`O°t? -------------------------------------------------------------------------Alterations and/or recommendat - <br /> :e- <br /> ------------------------------------ <br /> t <br /> ------------------------- <br /> -------f / /------ --- <br /> FINAL INSPECTION BY'.-A,/", <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br />� <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> F.P.0 Q. <br />