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FOR OFFICE USE: <br /> -- ---- ------ <br /> --I <br /> . -_ <br /> ------2 6�-._ APPLICATION FOR SANITATION PERMIT Permit No. _/.--9.... ----- <br /> -- <br /> ---- - " <br /> ----11"v.- ------- (Complete in Duplicate) , 6 <br /> j-1--K `� 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 CAT N_._ - f <br /> -------- --- - <br /> Owner's Name---------- ....tf s -•-- ------------- - -- --- <br /> _ <br /> Address --------- ---------1_(--------------------------------------------- ...---- = ---------------------------------/--- ......... ---_---f <br /> Contractor's Name----- _00 - - _ _ --�1'-/ - -------- --- Phone-'�4ZJ5.__^_X_2 <br /> Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Numb f bedrooms .Number of baths __/._ Lot size J_._ --' -- <br /> Water Supply: Public system ommunity system [;,,.private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel n Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ <br /> Previous Application Made: (If yes,date-___ ------- ) -No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICAT16NS <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se Tank: Distance from nearest well-------------.---Distance from foundation-------------------.Material_________________________________"__..-..____--_. <br /> No. of compartments--. - Siz4____ '-•_-"_________________---Liquid de th-__.___ <br /> Capacity <br /> Is osal Distance from neares well-- G +-�Distance from foundation__�� � Distance to nearest lot line--. <br /> --- --------- r ----z-(. <br /> Number of lines______ _ _..__.___ _ . Length of each line__._ ___ �i Width of trench *�- d <br /> Type o filter material_ epth of filter materiaL__/�-_ _- ._ Total length-__.__.__._ �r� -_._ __" <br /> -C � - "-- <br /> Seepage Pit: Distance to nearest well__________________ __Distance from foundation___--.__-__-______-.Distance to nearest lot line--.- ___- <br /> El Number of pits------- Lining material-----------------------Size: Diameter-----------------------Depth..."_.-__---__--.___--._-._-• �1 <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 /> ❑ Distance to nearest lot line------------------------------------------------- ----------------------------------------------"---------------------------------------- <br /> Remodeling and/or repairing (describe)--------------- ---- -------- <br /> ---- -- -------------- <br /> ------------------------------------------------------•---.---- <br /> --------------------------------------------------------------------- -- - - --- -------------- -- ------------------------ ------ --------------------- --------------------- <br /> - --------- -------- ---- -------- ----- -- -- -- ---- ----- ---- ---- -------------- ------- -- ------�- -------------------------------------------- <br /> I hereby certify th have prepared this application and hat the work will be done in accordance with San Joaquin County <br /> ordinances, State laws rules and regulations of the Sa J quip Local Health District. <br /> 2.y & //ig4t <br /> (Signed) SEPTIi:."TAITIFC""SERVICE------------------------------ - ''(Bw Contractor) <br /> g .2915 E.Minor Ave., • HO.6-3841 Title. <br /> • ---------•----------. --------•------•------------------------------------ ------------------------------- ------------------------------------------ ---- --------- <br /> Y (Title) <br /> (Plot plan, showing size of lot, location of system in rela o t wells, buildings, tc., can be placed on reverse side). <br /> FOR DEPARTMENT SE ONLY <br /> APPLICATION ACCEPTED BY-------- ----------------------- DATE______- _. '----------------------------------- <br /> REVIEWEDBY------------------------- - ------------ -------------------------------------------------------------------------- DATE---------------------------------- ------------------------- <br /> BUILDING PERMIT ISSUED------------- ------ DATE--------------------------------------- ------ -------------- <br /> Alterations and/or recommendations:_------- ---------------------------------------------------------------------------_----------------------------------------------------------------- <br /> -------­-----------I------------------------------------------------------- <br /> --------------"-•------------------------------------------------------------------- ------------------- ------------------- ------------------------------------------------------------------------ --------------------- <br /> -------"------------- -------"------- -----------"------------------------------------------------------------------------------------------• ----------------------------- -----------------------------.:_".----- <br /> ------------------ ------ ----------- --------------------------- ---------/- ----------------------------------------- <br /> / ------------------------------------------------------------ ------""...---------- <br /> FINAL INSPECTION BY:.--- '_ ... --L ----- �--- Date-------- -- 7/_ �5— �`� ---- ---- - -------- <br /> S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton 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 /> �k, <br />