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FOR OFFICE USE: <br /> --------------------------------- <br /> ------------------------ <br /> ------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. _ __ _.._....�.. <br /> - ----------------- ------------ ----- (Complete-in Duplicate) g <br /> Date Issued <br /> ......... This Permit Expires 1 Year From Dato 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 a plic tion.is made in compliance with County Ordinance No. 549. �9- .3( to, r;> CI°1 <br /> JOB AD RESS AND LOCATIONf � �.----- -------- '-- ` <br /> � _ <br /> J. <br /> Owner's Name. �`/V�ll-(_­- I�/ 66i- ------ ----------------------------- <br /> cl <br /> Address. .__.._._ <br /> Contractor's Name---- ._--f/l - '7-- ._[/ --------- ------- --- Phone__�l , _c _. . <br /> - ----- ----------------- ------------•-- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ <br /> r <br /> Number of living units: -- ----- Number of bedrooms ------.- Number of baths-------- Lot size ----- .` -------- <br /> -------- ----------------------------------�/ <br /> Water Supply: Public system ❑ Community system [] Private4[?r""Depth to Water Table ft a <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑ YSand Loam-E] ClayLoam ❑ Clay E] Adobe E] Hardpan C] F 4!3 <br /> Previous Application Made: (If yes date........ ) No New Construction: Yes Fr No ❑ FHA/VA: Yes ❑ No [ � <br /> _TYPE OF INSTALL"ATION-AND SPECIFICATIONS: _ - - • <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Septic Tank: Distance from nearest well _-_Distant from foundation-__. .0------Materi I --- <br /> - +-Z'�'��'--- <br /> _ - <br /> No. of compartments-----;? Size__ ___ ._10 __ ._ _Liquid de th-.. ]. .. .. __. Ca otic , v---_-_ II <br /> ® P ----. - -- q P. Z: P y-- -. k <br /> Disposal Field: Distance from nearest well..- `r" C>.-Distance from foundation----/_v........Distance to nearest lot line----- `?_-.----. Y <br /> c <br /> Number of lines----------- ..................Length of each line__,----- -Q0 Width of trench_._._��__._.___._...__._____._. <br /> Type of filter material____ . _-......Depth of filter material._.. _.___.....Total length----A!�0------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------------_-.Distance to nearest lot line__._- ._______- <br /> ❑ Number of pits--- -------------s` Lining material--------........__---. Size: Diameter--.--------------------Depth-------------------------------. <br /> Cesspool: Distance from nearest well ________________Distance from foundation................. ..Lining material----------------------------------- -- <br /> ❑El <br /> Size: Diameter- -- ---- ---- ----- ------------`---Depth---------------------------------------------------.Liquid Capacity- ----------•--------------.gals. <br /> Privy: Distance from nearest�welL___:aR,..°- --------- -----_- -__-______Distance from nearest building,........._---.__.-._-_--------_-.--. 1 <br /> ❑ Distance to nearest lot line .----------------------------------------- ----------------------------------------------I <br /> and/or epair'ng (describe)-------- --------------------------- --- - -•----------••------- -- - -------------- - �- --- --- ------- ---•-----•-- <br /> ----fAV 671il.� ------- --- / --- . . <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, Statelaws, and rules and regulations of the San Joaquin Local Health District. <br /> --(Signed)- --?--'---: P/.�a'1 -------------------------- --- -- -�---- -- ---- ---- ;(Owner and/or Contract <br /> BY:-------------------------------- --------------------------------------------------------- --------•--------------------- --------(Title)----------------- ------- <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 /> I <br /> APPLICATION ACCEPTED BY---------` .I_IZ. ---------- ---- --------------- DATE-- ----{ `�j7--------- ---------------- <br /> REVIEWEDBY---------------- -------------------------- ------------------------------------------------------------------------------ DATE--------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------ 7-------.- --------------------------------­­--------- --------------- <br /> Alterations and/or recommendations:..... - ----- ----- ---------------------------------------------------------­­-------- ------------------ <br /> ... <br /> - ------------------------•------------------------- -•---•--------------------------- <br /> ... ........... ----------Tlw i_._.!/V-STf1 LLf=7D.---- `ro----- A.CKF7147�--------- �'i-6fl.r--- <br /> ------------------------ ------- -------------------- ---------------- -------r----------------------------------- ------- <br /> -------- -------- ------ --------------- -- ---------------- --- ---- ------------------------------------------------------------- - -------- ---- ---------- ----------- ----- <br /> ........................ --- - --- ----- - ------• ------------------------------------------------------------ ------------ --------- - - -------- ------ ----------------------------- <br /> FINAL INSPECTION B - Date , `... ...... ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> r <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 21%1.67 Vunguard Press <br />