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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No.---------------- <br /> .v <br /> -------------------- -- ---------------------- -- <br /> - (Complete in Duplicate) <br /> Date Issued <br /> -_----------------_----------------------------------.--- I 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 <br /> //��Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION__X - ------_t_ _ -_?x---Qce. - . , ___..__ . _ �LG_� -----/�`'� !- <br /> - ------------------------------------ <br /> Owner's Name. E... �� - - L-f--------- v / ----- P <br /> - - -- - - - <br /> Address ---• J------ > -- p-�--/-------------- <br /> Contiiactor's Name--- ------ -------------S.(/-- -. --------- ------------- -----.---- Phone3U .1. <br /> Installation will serve: Residence [ Apartment House ) Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __j----- Number of bedrooms;__-_ Numbers of baths .C.,-- Lot size -----C71(�. ------la" q/ ._.., <br /> Water Supply: Public system ❑ Community system Private O` Depth to Water Table/Q0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel:❑ Sandy Lpam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan F <br /> Previous Application Made: (If yes,date.--_____- ----) No 4:X Construction: Yes ❑ No j5__FHA/VA: Yes ❑ No D< <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic,tank or cesspool permitted if public sgy#er is available-Tit ain.,201)-feeta <br /> Septic Tank Distance from nearest well .--- Distance from foundation _ <br /> - _.-_ ---Material ---------- -----------_ . <br /> ❑9y-t5���r . No. of compartments--------------------------Size---------------- _t _. _:__-Liquid de�th-__-._ -___-- . _Capacity-_-__ <br /> ` ...... <br /> Disposal Field: °. Distance from nearest well -rp-Q -�'t�!istance from f�undafion /-SDistance to nearest lot line._.�S_..... <br /> VNumber of lines- L"'.`_ _. ..' �� -47LL�e�ngth of each line---/-G Q._` Width, of trench..Z.��--____ ____________ <br /> Type of filter material.__l� -.-- jib&pth of filter material---_-Vit- .---Total length--� �-f-.P_�z_�.. <br /> co <br /> Seepage Pit: Distance to nearest well V-15.-____-____Distance from f' ndation-_--/-Z�Dist��ce to nearest Igt (ine� S___._ <br /> Number of pits-.�1'?^ -_ Lining material-�E�---Size: Diameter ----Depth---G---e ---------- ----- <br /> C,esspool: Distance from nearest well-,-'-----.--.-.__Distance from ----------------Lining material----. ._.... <br /> -_------------------- <br /> Size: <br /> - ------------------ <br /> Size: Diameter --------- ----------------Depth----- -------- --------------------Liquid Capadity --------- -- ---------gals. <br /> r <br /> Distance from nearest well;-----------------------.. E Distance from nearest building ---------------------------- <br /> Privy: ....... .i. <br /> ❑ Distance to nearest lot line _--.. _. ---------------,________________ _____-_ . .-__. -_.--_ <br /> Remodeling and/or repairing (describe c' - ---------------------------------------------------- <br /> 6 <br /> ----------------- ------------------------•----- <br /> -•-- ----------------------- - --- --- ----- -- ---- --- <br /> --- • ...... ------- ........ ---------. r '°*� -------- - - <br /> iI ---------------------- <br /> I <br /> --- ----------------------------------------------------------------------------------------- <br /> I hereby certify that [ have.prep this appliclati n and that p11el work will be done in accordance with San Joaquin County <br /> Oroordinances, State laws, and rules an re lations of <br /> San Joa_qu ` cal Health District. <br /> V <br /> (Signed)--------------------------------------------- -- --- -- ------ ----- -, ---------------------- ----- (Owner and/or Contract <br /> By:------------------------------------------------ -- -- -------' -- - --------- -----(Title)------- - ' — ,-.-. ''. <br /> (Plot plan, showing size of lot, IocatiorYpf system in cele ion toavells, buildings, etc., can be place n reverse Slde). <br /> FOR DEPARTMENT UiSE ONLY <br /> APPLICATION AC Q ----- --_ - -- DATE <br /> REVIEWEDBY -------- --------- -- - - - ----- ------ - --------------- DATE -----f----------------------------------------------- - <br /> BUILDING-PERMIT ISSUED_--------------------------- - -- ----=-- --------- ------4----- ------- DATE i <br /> Alterations and/or recommendations .. __. - ----__ --------------- -------------------------------------------------- <br /> ------------------------- ------.----- -- <br /> ----- � �-----� - ------------------------------------------------ <br /> --------------------- --- <br /> FINAL:- NS�'ECTION BY:._...- _._.. <br /> � - <br /> _ Date.------J-- --� ------ -- - ---------- •---- <br /> SA JOAQUIN LOCAL HE DISTRICT <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.CO. <br />