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FOR OFFICE USE: <br /> ----------------------------- ----I--------------------- <br /> ------- <br /> -------------- ----- p <br /> ------_-_----- _--.- APPLICATION FOR SANITATION PERMIT Permit No. c _O_/.-�' <br /> -4� - ----- (Complete in Duplicate) <br /> This Permit Expires i Year From Date Issued <br /> 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.i.n compliance with County Ordinance No. 549. A-?"U 2-5--3 0C)-02_. <br /> JOB ADDRESS AN OCATION__..- Ih � `)Y[.t�� ='Q`d�l'!/l.{r �l'�''J <br /> --------------- <br /> Owner's Name __--.-�!%��------- -------- - - --- - -----0C37.-n4 --= - --- ------------ --------------------- Phon --------------------------------- <br /> Address-- <br /> -----------------------------Address__..--- l rr�� — ---- - <br /> ----------------------------- <br /> Contractor's Name-- •------- -----------•----•------------------ ------------------•------------------------------------------- Phone----------------------------------- <br /> Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trail r Court ❑ Mot I Other ❑ <br /> • / <br /> Number of living units; �------ Number of;bedrooms- _. Number of baths _ Lot size -___ ...�_ __ __ ___ _________ ___________________ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table daft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 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: V1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well._.4_0--.---Distance-from fou dation_-_-/_4-.____.Matgr'a]----_h�,Z, - _______- <br /> No. of tom artments_. ._ .. Size__ ._ __-. __ _;�___:___Liquid depth_______ ___ __________ apacity_ ����--___ <br /> P t� �. <br /> Displ Field; Distance from nearest wel!--- _..._Distance from fouridatio ' Distance to nearest lot <br /> Number of lines____ <br /> -----,__-- ength of each linen............ ".Width of trench----- _ - t , <br /> ( t : f� <br /> Type of filter matoriaL._S_�_� - �ep#h csf;filter material..__���i-.-._-.-___.Total <br /> hIC J'• M�:1 <br /> See a e Pit: Dis#ante to nearest well /(�_(�_.-___Distance from fo nt�a#ion�,(� t! ,Distance tp�aresf)o <br /> Number of pits---.�_._--- . _Lining material- _ _-- iameter�X]/�x1pth-- :1- -- ----- -------- U <br /> Cesspool: Distance from nearest well-------------_---Distance from ounclation--------------._ _.Lining,material___-.__..-___._______._____________- 'h <br /> ❑ Size: Diameter- --------------------------------Depth--- ------------ - -- =-Liquide-Capacity-.------ -------------------gals!_V_. .�= - .ir« *-�..-..� *----,-.J ` max...- _,-�-� V. f <br />"°" Priv'yt"�"""' -'"Distance from"nearest well"""" • •--- _ ,Distance from nearest buildin <br /> ❑ Distance to nearest lot line------------------------------------- _ %s s -., f ` n <br /> --- - ------------I----- ----------------- ----------'------------------------------- <br /> Remodeling and/or repairiag,(describe):-- ----- £�/_ _�-t -(_.�j�t� � ----- �� ----- ~� <br /> ----------------------------------------- -f (�` t '` �! -'� L�2 <br /> q - <br /> --------------------------------------- ---------- - - ------ <br /> i <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 regulations of the San Joaquin Local Health District. <br /> (Signed)--------------------------------------------- ------------------------------------ ----------------------------------------------------- -------(OWner and/or Contractor) <br /> By------------------------- ----(Title) I <br /> ------ ----------- -- ---------------- <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 i <br /> REVIEWED BY ---- -------------- ----------------------- --- -I h--- r�DATE------------ = <br /> ------------------------------------ --- <br /> APPLICATION ACCEPTED BY--------------- � <br /> ------------------- --------------------------------------------------------------------- -- --- ----' --- DATE------------------------ <br /> BUILDING PERMIT ISSUED ='----------------------------•---•-------------------: DATE......... ', --------------- <br /> Alterations and/or recommendations:------- --------- __-. <br /> ------------------_-.-_ ..----------- ----------------------- f-''�__ <br /> Z--- - <br /> --- ------------------ ----- -------------------- <br /> r e <br /> --------------- -------------------------- ------. ---- <br /> ----- - --------------------------------------------------- -- ----------------------------- <br /> FINAL INSPECTION BY:_.---- ------ -- ................... =----G'--4/ Date------------.. � ....... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:etton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Catifornia Lodi,California Manteca,California Tracy,California <br /> r.P.00. <br />