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FOR OFFICE USE: <br />--------------------------------------------------------- <br />_____________________ __ APPLICATION FOR SANITATION PERMIT Permit No. _4112.-.f.:_1` 3 <br />--------------- --- -�- ------------ ------ (Complete-in Duplicate) <br /> 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 /> JOB ADDRESS A�ND�0C TION G._ _ _ -___._ �'r.ESC tt....0 '�'` <br /> Owner's Name-fit-----�.... 2Z. ------------------ <br /> ------------ ---- -- -------- - -------- Phone------------------------------------ <br /> - -- <br /> Address.............. `1_. - f '"�=---•----....-- =�'�T ----- ........................................... <br /> --------------- ----------------------------------------------! <br /> Contractor's Name._.__ ..--•-•- -• -• ---- -•- ---*-- --------•-•----- Phone................................... <br /> Installation will serve: Residence [Apartment House E] Commercial F] Trailer Court ❑ Motel C-] Other ❑ <br /> Number of living units: -- 1-- Number of bedrooms -------- Number of baths-/---- Lot size --- —------------------------ <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 E!r 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 permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material --___---_-.._..-_--__._..--___--_--_---.-_.___.. <br /> ❑ No. of compartments--------------------- ---Size--------------------------...Liquid depth--------- ------- ------ Capacity----------------------- <br /> Dis Field: Distance from nearest well--- ��-r.-Distance from foundation-------/_D./..Distance to nearest lot line__�........ <br /> Number of lines------------- y <br /> .�-----------------Length of each line____-- ----------.--��_--.Width of trench----------�----•---------------_-- <br /> Type of filter material-_--._-_.51--------Depth of filter material-------1._- ..___---Total length--.-.-_�U___________________________ <br /> Distance to nearest well___ `a_.__-_.__Distance from foundation-----/0. .___.Distance to nearest Iodine__X../-__-..- <br /> ❑ Number of pits._ /-.------Lining material___-_ Size: Depth_.j?�..-._.-_-_-_.__-_--_-._ <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) ------------------ w ---• --------I-------------------------- •----------------------- <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 I s,' d rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------------- --- - -- ----- ---- ..... ------- --------------------------- -_--------------------- �„�+'e�IORlI"dR�/or Contractor <br /> By:..... ✓•_-------`-`--- -- -- ----- - ---------- -----(Title)----- -------- .- -- -- -- -- .. .----- --------- <br /> (Plot plan, showing'size of lot, location of system in re tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.__ - ._ -______________----- DATE-__�._". .__�." <br /> REVIEWEDBY----------------------------------- --------------------------- ---------------------------------------------------------- DATE------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------- ---•------------------- --------------- DATE----------- ---- <br /> Alterations and/or recommendations---------------- ----- ------------------ ---•-------------------- ----------------------- ----------------------------------------------------------- <br /> ------------------------------------------------------------------- -------------- -------------------------------------------------- <br /> ----------------------------------------•----------- ---•-------------------------------------------------------------------- --------------------------------------------... <br /> ------------- -------------------------------•------- ------------------ -------------. -- ------- --- ---- ---------------. _-------- <br /> -------------------------- -------------------------------- -------...------------------------------------- -------------------- ---------- - _ <br /> 4- <br /> SAN <br /> -------- ------ <br /> FINAL INSPECTION -------- Date_.-/- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601-E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 vanguard Press <br />