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FOR OFFICE USE:, <br /> APPLICATION FOR SANITATION PERMIT Permit No. 42.1141p7 <br /> ------------ ------------- ------------------------------ <br /> __________ _. _ , .-. (Completejn Duplicate) <br /> 11This 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 LOCATION -- <br /> _ �.----------- <br /> Owner's Name.---------.1/(�......• -- ----- Phone----------------------------------- <br /> Address.................... ---•-- -••-•- --------------------- <br /> Contractor's Name-...... ------------------------------------•--•----------------------------------------•-----•----•-•--•-------•-- Phone............................ <br /> Installation will serve: Residence [Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: __4_-_ Number of bedrooms . _--_ Number of baths'1 . Lot size __9 ---------- ----------------- <br /> Water Supply: Public system ❑ Community system ❑ Private R] Depth to Water Table 47 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam IM 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_septic tank.or-cesspool-permifted-.if public sewer46 available-within 200 feet:4, _. <br /> Septic Tank: Distance from nearest well___ b___..__Distanc fro fou_ ation. --�Y!--------- <br /> _#4 .Mat rial .. . ................ ...................... <br /> No. of compartments -------------Size _��_�f' � ..Li Liquid de th_.---_-�..... ........Ca acit ��'" <br /> I P - q P. P Y ----•- <br /> Disposal Field: Distance from nearest well_.-�_0._ ...Distance from foundatiQQ�yn..t_P_•---___..Distance to nearest lot line•__3_--_-.____. �s. <br /> IV Number of lines-----3___________ --- ---------Length of each line______s�.�_.__ Width of trench._ ;___-_.---_..__.-_-.--•-- <br /> Type of filter material_ �.�-t__--_------Depth of filter material----1_P____ _______Total length_-- ___.......................... <br /> Seepage Pit: Distance to nearest well-.---._._-_-_-_-_-__Distance from foundation....................Distance to nearest lot line_-------_--.__-._ �.. <br /> ❑ Number of pits.__..------------- Lining material__----_.--_----.-.__ Size: Diameter_______________________Depth__._.__.-._-__-__-_-.-__:--____-. p� <br /> Cesspool: Distance from nearest well ----_--.--_--_Distance from foundation_________________ __Lining material...._.-_-.--._.-_._.-__-.--_._....-- <br /> ❑ Size: Diameter- -- -------------- ---------.Depth------------------------------------ ---------------Liquid Capacity----- ----------------_....gals. <br /> Privy: Distance from nearest well-------------------------------------------- from nearest building-------.------.___-__________-----.-__--- <br /> ❑ Distance to nearest lot line-------- -----------------------------------------------..._..-----•--------•------•------------------- --------------------------_ <br /> Remodelingand/or repairing (describe):------------------------ ------------------------------------------------------------------------------ ............................................... <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 rules and regul ions of the San Joaquin Local Health District. <br /> (Signed)... . -- -------------------------------------•-------------------------------------(Owner and/or Contractor) <br /> B ...........-......._.. •........(7i#IeJ =>---- ------ --------- ------------------ <br /> (Plot <br /> - ----- -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------ ------ DATE--- -- 1.47.-------- <br /> REVIEWEDBY..... ------------------- ----------- -------------------------------------------------- ---------------------- --------- DATE-------------------------------_................•----•---- <br /> BUILDINGPERMIT ISSUED......... -----------_------------------------------------------- -------------- DATE------------------------------ -------------........... <br /> Alterationsand/or recommendations--------- ------ -------------- --------------. __----._........ ----------- ...................................................................... <br /> --------------------------------------------------------------------------------- -----__ ------------ .......................................................... <br /> ----------------------------------- --------------------------------------- -------------------------------------------------- --------------------------------------------------------------------•----------------------- <br /> ------------------------ ---­-------------------- --------_--- -. ----------- --------------------------------------- --------- --------------- ..... ---------- ------.---------------- <br /> FINAL INSPECTION Date . "r......-- ----- - <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 /> E.H.9 2M 1-67 Vanguard Press <br />