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-gym-�� .•,ter} <br /> FOR OFFICE USE: <br /> ------------ --- - --------- ------------- ------------- <br /> ........-___--_------------------------ ---- ----------- APPLICATION FOR SANITATION PERMIT Permit No.,!_Y7.. <br /> ---------- ­---------- ---------------- (Complete in Duplicate) - <br /> - This Permit Expires 1 Year From Date Issued " 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 OCA710N fes_�' �-� -- oof------- 4rx�ru►'--------4-:W; -------------------- <br /> Owner's Name-------- --_,_Xi-----•- --------.-.- Phone------------------------------------ <br /> p <br /> Address--------------�'.�L� ._ -• -�----- ----- � ------ ---- ---------------------------------------------• <br /> Contractor's Name...... y �------------------------------------------------------------------------------------------------------------------- Phone----------••----------------------- <br /> i <br /> Installation will serve: Residence "'i" Apartment House El Commercial E] Trailer Court ❑ Motel ❑ Other ❑y <br /> Number of living units: A____ Number of bedrooms __-! Number of baths Lot size -___.'_7__'1..r_-_x_1_`3.7__ <br /> Water Supply: Public system A Community system ❑ Private ❑ Depth to Water Table _70 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 9 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date-------- ----------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:- <br /> (No <br /> PECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-e2.. ___-_-Distance fr m foundafion__-_f IR........ Material____________________ ________ __ ____________ <br /> ® No. of compartments.____ -_-......-__Size_. '_ 'r S`--.---Liquid depth------- --------------Capacity___t t ' _____-- <br /> Disposal Field: Distance from nearer, well_'97�?-------Distance from foundation----/jP°------Distance to nearest lot line---.f <br /> [ ] Number of lines______ _________ _ Length of each line___ -_( O! -_---------Width of french.__49 --------------- <br /> ---------------------------- <br /> Seepage <br /> �----.--_____--. <br /> Type of filter materra!�-- p °` <br /> De th of filter material--_/----- ....Total length--- 1 ----------------------- -- <br /> Seepage Pit: Distance to nearest well--_------------------Distance from foundation_________--__-___.Distance to nearest lot line----------------- <br /> ❑ dumber of pits----------------------Lining material------.---------_ ---- Size: Diameter-----------------------Depfh--------------------------------- <br /> Cesspoof: Distance from nearest well-----------------Distance from foundation------------------ material---___.-.-_---_-------:________._-_- <br /> ❑ Size: Diameter-------------------------- - --------Depth-----------------------------------------y---------Liquid Capacity-------------- -------------gals. <br /> Privy: Distance from nearest well------__-----------------------------------------Distance from nearest building,-._._.____----________--_____.-_______.-_ <br /> ❑ Distance to nearest lot line------ -------------•-------- ---- ---------- --------------------, <br /> Remodelingand/or repairing (describe):------ -------------- ------------------- -------------------------------------------------------------------------------------------------------------- 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 laws, and rules and regulations of the San Joaquin Local Health District. 4 <br /> {Signed) - = ----------------------------------------------------- -- <br /> I <br /> -----------(Owner and/or Contractor) <br /> By:--------------------------------------------------------------------------- -,' <br /> - -------------------------------------------- -----(Title)------------------ -- ------- -------- --- -------------- --- <br /> (Plot plan, showing size of lot, location of system in relation to wells,,buildings, eft., can be placed on reverse side). j <br /> FOR DEPARTMENT USE ONLY <br /> A , <br /> APPLICATION ACCEP D BY--- ---------------------------------------------------- bA7E- --------- ------------------ <br /> REVIEWEDBY__L-_1_/1------------------------------- ------------------------------------------------------------------ DATE--- L�.y.-G <br /> BUILDING PERMIT ISSUED------------------------------------------------ ------------------------- --------- DATE.- ------------------------ ------------- <br /> Alterations and/or recommendations------------------------ -- - --------- ---------------•---------------------- -- <br /> -------------I------------------ <br /> ---------•--------------------- ------ ------------------------------------ -------- -------------------------------------------------•------------------------•---- ---------•---------•--------•--------............... <br /> --------------------------------- -- ------ ----------------- --------- ---- ------------------------------------------- -------------------------------- ----------- ----------------------------------- ----------------- <br /> ==------------- -- ------------------ -------------- ------------------ ---------- --------- ---...----------------------------------------------------------- -------- -- ------------ <br /> ------------ <br /> FINAL INSPECTION BY:. --- -- - --------- Date...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT i <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 /> F.P.CC. <br /> 4 <br />