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FOR OFFICE USE: <br /> ----------- <br /> APPLICATIOCFM- SANITATION PERMIT Permit No. :1.2-1 <br /> ----------------- r <br /> --- -------------=---- (Complete in Duplicate) 2 <br /> --------------------4------------ ----------------- This Permit Expires 1 Year From pate Issued <br /> Date Issued/-c---:­/­`�.-4-.Z <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----- 05-30---- --------- - --- .....W6 --------- -------------------------------------------------- <br /> Owner's --- <br /> .. ........ . -- -- - ----------------------- --------- ---------------------------------- ------ Phone.-9.,3/:71-2-AR-(:F <br /> Address j.-jo....e3ax..,3— -/------------- ------ ....................................................................................... <br /> --------------------------------------- Phone..1.Zk-y1jr9-7.... <br /> Contractor's NameWo..A--- --- --- -U.. - ---- --- --------------------------------- <br /> Installation will serve: Residence 0 Apartment House [] Commercial E] Trailer Court E] Motel 0 Other El <br /> Number of living units: __-L-.- Number of bedrooms --Z--- Number of baths ---I--- Lot size ---100- C-----1,T-0------------------------------ <br /> Water Supply: Public system El Community system E] Private W Depth to Water Table -------- ft.I <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam D Clay Loam El Clay El AdolSeiM Hardpan 0 <br /> Previous Application Made: (if yes,date.---------I----------) No E] New Construction: Yes [fl No E] FHA/VA: Yes 7 No Z <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 /> Liquid depth--------------- ---------Capacity----------------------- <br /> 171 No. of compartments-------------------------Size..... --------------------- <br /> Disposal Field: Distance from nearest well----/0---.---Distarica, from foundation-_-.;Z.0---------Distance to nearest lot line---/0--------- <br /> EA Number of lines--------J--------t_-.-_- Length of each line_--.--_-_--2,0''-----------Width of trench.._....Zq-- ------------ <br /> Type'of filter material__-- ----,--`De0h of filter material-------16..............Total length-.-.----------- --------- <br /> Seepage Pit: DistalP ce to nearest well---Icia---..----_--Distance from foundation----A�_---------Distance to nearest lot <br /> X <br /> Number of pits...Distake from nearest well-----------------Distance from foundation-------------------Lining material__....._____.._.__._ _______---------------i--------------Lining material---- -----Size: Diameter--2-l"----- ----Depth-------;L1--'. <br /> -------- <br /> Cesspool: -------- <br /> El Slze::biameter----- ------------------------------Depth-------- ---------------------';---------------------Liquid I Capacity............................gals. <br /> Privy: Distance from nearest well----- -------------------------------------------Distap' ce from nearest building------------------------------------------ C� <br /> F1 Distance to nearest lot line:__--: --------------------------------------------- ------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):----- -------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------------------I-------- ----------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> --------------------- ------------ -----------------------------------------------------------------------------------W------------------------------- ------------------------------------------------------------- <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 laws, and rules and regul&+#*ns of the-64in, J466juih,jLI-W <br /> a f4alth District. <br /> (Signed)� 14- -------------------------- ------------------------------------------------ --------------------.(Owner and/or Contractor <br /> -------------- <br /> ------- <br /> By:—nvh4l.e�� ------------------------------------------------------------------------ ------------ --------------- - ------- <br /> (Plot plan, showing size of lot, location of syst.bm in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ --------------- DATE--------- ........................ <br /> REVIEWEDBY-------------------------------------` I---------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED............... -------------- ------------------------------ DATE------------------------------------------------------------- <br /> " 2 -- ,2 ----------------------------------------------------------------------------------- <br /> -V--------------- <br /> --------------- <br /> Alterations and/or recommendations:-----------Z' '- ...... <br /> ---------------------------- ------------------------------------------------ --------- ----------- -------------------------------------------. <br /> ------------------------------------------ ----------------------------- --------------------------------------------- --------------------------------------------------------------- ---------------------------------- <br /> --------------------------------------------------------------------------------------------- --------------- ------ -------------------------------------------------------------------- ----------------------............ <br /> ------------------------------------------- ---------------------------------------------------- ......... -------------------------------------------------------- -------------------------------------------- <br /> FINAL INSPECTION BY:.-------- ---------------- Date.--- 0�------------------------------------------- <br /> ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />