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FOR OFFICE USE: <br /> ���•z� r-------------- <br /> ._ APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) /d <br />--- ------------4-i-- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health Dist ' t for a permit construct and install the work herein described. <br /> This application is made in compliance with County Ordinance 549. <br /> JOB ADDRESS D tOC -------- <br /> n ---- -------------- f• ----------------- <br /> �f---�------ ---- / . . <br /> Owner's Name // - - <br /> - - Phot�p !!_ .C.l-� <br /> Address-------------- (!� ------ ... ---- --- ------------------------------------------------------------------------------------------------ <br /> Contractor's Name-------------------------- -- -- - - ----- ------------ ---- -- -- ---t---•----------------------------•-------- Phon .--- -• � -- - <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..----- Number of bedrooms _Number of baths j----- Lot size -.75_____x-- -, �-------•-------------- <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 j 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 septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation.___-_-_--..--.__.-.Material---.-_----_--_-_-_--__--.--._-_-____-.-..__-_---. <br /> 0&15,�ti'VGNo. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity-------------------•--- <br /> Disposal Field: Distance from nearest welIA90,015I Distance from foundation..., s----------Distance to nearest lot line-. 3-S--_�. <br /> Number of lines_____________ __t _._._--_-Length of each line------- ff Width of trench.-_.-__--__--- _-__--....__--__-- <br /> Type of filter material_�_1_-9-46--Depth of filter material.-_�_�L-_--__._-�.-Total length-----,�-Q__________________________ "� <br /> r <br /> Seepage Pit: Distance to nearest well__l�fl_l_0?.._.-Distance frot"�foundation__._-:........Distance to near <br /> est lot line__,�.�___._ <br /> Number of pits,1�-e-�-)--Lining mate ria l-�vW42Size: Diameter__.33.3---_.-__-Depth__2__, <br /> Cesspool: Distance from nearest well----------.---...Distance from foundation--------------------Lining material----------------------------•-..__-_- t <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)---------------- ----- -- -- ------ --------- ------ --- -- ------ ---- -1----- ----- --- <br /> ------------I--­------------------------ <br /> ------------------------------------------ ------------------------------------------------------------------------------------------------------------- ------------ -------------------------------------------------------- <br /> -------------- <br /> ---------- <br /> ---- ----------------------------------------------------------------------------------------------------------------------=-----•------------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------•---------------------------•------------•-------------------------------------------------•------------------------------------------------ <br /> I hereby certify that I ave preps"red this application a d that the work will be done in accordance with San Joaquin County <br /> ordinances, State,laws, an rule and regulations of the S Joaquin Loc alth District. <br /> (Signed)---------------- ---- ------------ - ---- ---- -- ; <br /> --- ----- caner and/or Contractor) <br /> BY: �yy� / y [ (Title) <br /> (Plot plan, showirtj size of o , ocation of system in relation to well , buildings, etc.) can be placed reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ----------------- ------------------------------ DATE------...... `-`} '- 4.47�------------- <br /> REVIEWEDBY--------------------------------------------- ------ -------------------- ---------------------- ------------------------_-- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------- --------------------- --------- DATE------------------------------------------------------------- <br /> Alter tions and/or recom end ions:___ .-..___.---__.____- ---_-- _ <br /> ------------------------- ------------- --------------------------- ------------------------------------------------------------------------------------------- --------------- -------------------- ---------------- <br /> I <br /> FINALINSPECTION BY:---------- -------------------------- ------- ------- Date---------------------------------------------------- ------------------------- <br /> SAN JOAQUIN LOCAL HEALTH 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 />