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FOR OFFICE USE: <br /> --------- ---N�------------------------------- <br /> _. - - (� ----_....- APPLICATION FOR SANITATION PERMIT Permit No. .��..l .l..� <br /> -- ---- ----------------- - --- - (Complete-in Duplicate) <br /> 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 compliances with County Ordinances No. 549. <br /> JOB ADDRESS AND LOCATION_. r ` /*lye_-___---?r=....05 Owner's Name t. �i/ Phoinece------------------------------------ <br /> 7 <br /> _../...7--- - - <br /> Address. •----------------- --------------------------- ------------------------------...... .............................................................. <br /> d_?L�:_. ._.._ _ <br /> Contractor's .---- e1�L ,20x <br /> Phone................................... <br /> Installation will serve: Residence [/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> f r r" <br /> Number of living units: I--- Number of bedroom . Number of baths__1-__ Lot size __�e�_. �.._7-*r <br /> Water Supply: Public system ❑ Community system ❑ Private [�epth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <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 /> Sqffis Distance from nearest well.................Distance from foundation--------------------Material -------.____--__._-_---_--_-_--__..._.---.--. <br /> No. of compartments----------- --------------Size-------------------------------Liquid dep/h�--------- ------- --- --- Capacity------ ---------------- <br /> Distance from nearest well. -.'A_Distance from foundation--- -----------Distance to nearest lot line__ ..... <br /> Number of lines__..___ __-._.._... _ ..._._Length of each line_ --------Width of trench__�� �---------- <br /> ,,Aid <br /> .-_._.r,._._ <br /> , Aid Type of filter materia_ -_-Depth of filter material--------F1��'"_'__Total length---------------------AM-____--- <br /> Seepage Pit: Distance to nearest well------------ --------Distance from foundation....................Distance to nearest lot line..._---.---__-.-- ,..� <br /> ❑ Number of pits__.-.---_.-.._-.----Lining material---------------------- Size: Diameter-----------------------Depth___-.----.-__._-___-.--.-____-_- .•.•� <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):--------- ------ ------------- -------- -----------AL1 --------I----------------- -------------------------------------------------------- <br /> ---------------------------------------------------------------------------••- -• - .............------- '------.�sC'1.yi,----------------------------------------------------------------------- <br /> ----------------------------- <br /> -- <br /> ----------------------- ------------------------ -----------------------........ ---------------------------------------------------------------------- <br /> I hereby certify that I have prepared this ap cati d that the work will be done in accordance with San Joaquin County <br /> ordinances, S aw nd rul and re lation f the an ocal ealth District. <br /> t � <br /> (Signed) - tom' --------------------- ----------�'�^e&-andAw Contractor) <br /> By:_--- / Title <br /> -------------------•• - -- ------------------= (Title) ------ -__.............. -- <br /> (Plot plan, showing size of lot, location of system in relatio o wells, build* s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- - ,_ Y - ------ DATE----- <br /> REVIEWEDBY--------------------------------------------- -------------------------------------------------- ------------------------- DATE-------------------------------------------------- <br /> BUILDING PERMIT ISSUED---------- -------------- DATE-------------------- - <br /> - ----------- <br /> Alterations and/or recommendations:--------- -------- ------- ---------------------- ------------------------------------------------------------------------ <br /> ------------ ----------------------- ------------------------------------------------------------ --------------------------------------- ---------- -------------- ------------------------------------------------------ <br /> --------- ---------------------- -------------------------------------- <br /> ----------------------------------- ------- -"- ­­------------------------- ------------------------------------------------------------ ---------------------------- ---------_--------------------- ------ <br /> ------------- --------- ---_---- ------ --------- --------- --_--- <br /> FINAL INSPECTION BY:----� ,✓f _ -------------- Date------ --------7`3 --- ----- <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 />