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FOR OFFICE USE: <br /> ------------- ------------------- ----------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------i <br /> x- . -------------------- -6s- <br /> ------­ __ llkl_ -------------- (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. <br /> --/------- <br /> Owner's <br /> ...... <br /> JOB ADDRESS AND LOCATION ------------ -----_------------ <br /> --- ............. <br /> Owner's Name Phone... <br /> --- -- ---------------------------- ------------------------------------------------------------ <br /> Address ..................... -------------------------------------------------------------------------------------- <br /> Contractor's Name...........A40 r4O-.---AW4.* <br /> — . .I- <br /> ....................... --------------------------------------------------------------- Phone................................... <br /> Installation will serve: Residence [Apartment House E] Commercial E] Trailer Court [] Motel 0 Other E] <br /> Number of living units: /--- Number of bedrooms S--- Number of baths A--- Lot size 000�%VX---94110 ----------------------- <br /> Water Supply: Public system El Community system E] Private 2TO'*Depth to Water Table _&V let. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 9�'Clay Loam El Clay El Adobe El Hardpan 0 <br /> Previous Application Made: (If yes,date------------- -------) No E— New Construction: Yes R?"No E] FHA/VA: Yes � No M <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.-4-40----- Distance from foundafi n---/,&0---------Maferial_&,e,' Oo�--------------- <br /> No. of compartments--,?-.-.---------------Size=rArwAeP4.X:ieW__Liquid clepth---- ---------------C a p a c i ty 41411AW..... <br /> Disposal Field: Distance from neares well-4-.0'..Distance from foundation..Za----------Distance to nearest I`t <br /> U?101� Number of lines-----j....................... Length of each line--ee--------------------Width of trench..--_--_---..-------..-.-.-.-- <br /> Type of filter mate ria L*40Depth of,filter material_.1,,F------Total length---- ��149------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- <br /> 0 Number of pits----------------------Lining material----------..--.-.-----.Size: Diameter.--------.-------.-----Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from'foundation--------------------Lining material--.-...-..-.-.---.-------------.-__ <br /> 1771 Size: Diameter-------- -----------------------------Depth----------------------------------------------------Liquid Capacity------------------------...gals. <br /> gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building........-..-_---------_-__-__-------...-.. <br /> ❑ <br /> uilding------------------------------------- <br /> 171 Distance to nearest lot line------------------------------------------------------------------- -1---------------------------------------------------------------------- <br /> oe- <br /> -------------------------------------------------------- <br /> Remodeling and/or repairing (describe):---------- '..-44, 7...410 W----•---•--- <br /> . -_--- <br /> --------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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 law;, and rule and regulatio of A San Joaquin Local Health District. <br /> and e V e <br /> -- - - --------- ----------- ---------------- ---- ---------------------------------------------(Ownei- sa4Vsr Contractorl <br /> (Signed)-------------------- .. ... <br /> By:....................................................................... --------------- -------- --------- --- <br /> (Plot plan, showing size of tot, location of system in wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_........--- -------------------------------------- DATE__--------- <br /> .. .. .. .. <br /> REVIEWED BY----- ------------------- ------ --------- ---- --------------------------------------------------------------------- DATE-- ...... . J ... ...... .... <br /> .......................... <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------_-­--------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:.----------------------------------------------------------------------------------------------------------------------------------- -----------_------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------............------------- <br /> --------------------- --------------------------------------------------­­------------------------------------------------------------------------------------------------------------ ----------------------------------- <br /> -------­-----------­-------- -------------------------------------------------------------------- --------------------------------- ---------- --------------------------------------------------------------------- <br /> ---------------------------------- -------- --------------------------- ...... ----------------I....................-------- ---------------------------------------------------------------------------------------------- <br /> P3/-65 <br /> FINAL INSPECTION 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 /> F.P.130. <br />