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FOR OFFICE USE: yt j p-360 <br /> .0 <br /> APPLICATION _FOR SANITATION PERMIT Permit No <br /> {Complete-in Duplicate) Date Issued .. <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. p� <br /> JOB ADDRESS AND LOCATION �... rl � �f4 - ... <br /> Owner's Name---, f l L ------------•--------------------- --- `--- <br /> - Phone----------- -------_--------------- <br /> Address......... ... <br /> ------_-----------"---Address------------- � -�-----� --------- ----------------------•--------- ----------------........-------------------- <br /> Contractor's Name--- -s --------------------------------------- ------- ----------------------------------------------- Phone...... ----_---------" <br /> Installation will serve: Residence Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of'living units: _. )---. Number of bedrooms ...3-. Number of baths --- -- Lot size 1.1.kx---a.-r,,p----- -------------------------------- 1 <br /> f <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 1.0— ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [s"Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date.-...-------------- ) Noe' New Construction: Yes 2r"'No ❑ FHA/VA: Yes No Q f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) \ <br /> Septic Tank: Distance from nearest well..'__ Distance from foundation. <br /> ----------.Material -- <br /> . No. of compartments-. _L, ............... .`I'-----.-...Liquid depth...-.f----------- --------Capacity...,_a--` V' <br /> � I <br /> Disposal Field: Distance from nearest well......___-_-Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 171 Number of lines.--"----------------- -------------Length of each line-- ------------------ -------.Width of trench.--------------------- ------------ , <br /> Type of filter material------..................Depth of filter material-----------------------Total length----------------------------------__----- <br /> I , i <br /> Seepag .Pit: Distance to nearest well----- -------------Distance from foundation-10............ Distance to nearest lot line.-._..--..- <br /> r i <br /> Number of pits_-_ ¢e:�..."._._.Lining matenal____ U.C1C-- SDiameter.. -.._..-.-...Depth..... ......................... <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 nearest building----------------------------------...._.. <br /> 0 Distance to nearest lot line --------- ------------- ...... - -------------------------------- ---------------------- ---------------------------------------------- <br /> s <br /> Remodelingand/or repairing (describe)------ - - ----------------------- ----------------------------------------•---------------------------------------------------------------------------- <br /> --------------- ------------- -------- -------------------------------------`--------------------------------------- ---------------------------------------------------- � <br /> -----------------------------------------------------------•---------------------------------- ------------------------------------------------------------------- -- - --------------- I <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 lawsZand ules and regulations of the San Joaquin Local Health District. <br /> {Signed..-- �° - --------------- - (Owner and/or Contractors <br /> By:-------------------_ --------------------- � --------- -- ----------------------- --------------------------- -------(Title)---------- -- - - ------ ................. i <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> + I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY r ------- ------ DATE-J—to- . <br /> ------------ <br /> REVIEWEDBY-------------------------------------- - --------------- ----------------r--------------------------------------- DATE----------------------------- ----------•------------------- <br /> BUILDING PERMIT ISSUED-------- -- --------" -. - '---- DATE--- ------------ <br /> Alterations and/or recommendations:-.. -.--- ----- ----- 'Q----- -----'" -- -- -•------- <br /> ------------- ----- <br /> * ----------------------------------------- - -------------•--------- ----------- ----------------- --------------- <br /> -- ``r,�� <br /> /lam -- <br /> --------------------------- -- <br /> - --------- ----------------- - --- - - -- - <br /> ----- --- --- ---------------- ...... ---------------- ---------------------------------------------------- -------------------------- --------------- <br /> -- <br /> FINAL INSPECTION BYDate.... l '! ----------------------- <br /> :.---�� �---f-4r��-- -��� �C� / � �- -- ------- - - -�- <br /> t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> 6 <br /> Stockton,California Loch, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />