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OR OFFICE USE: <br /> APPLICATION AOR-SANITATION PERMIT .Permit flo. .� 1_. . <br /> --- ------------------ ----------- ----- -------------- <br /> [Complete in Duplicate} 7� <br /> -- -------------- / <br /> " - Date Issued .�.�-.. ._�. <br /> ---------_------"------ --_--- _____..__--....--_ ;This Permit Expires I 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 Ordin WN ��� <br /> JOB ADDRESS AND OCATION-------.CRO-45p. ----------- - -- ------------------------------------------------------------------------------------------ <br /> Owner's Name --------- Phone <br /> ----- ------------------------------------ - ---- <br /> Address----- ------------- ` � <br /> - ..- <br /> Contractor's Name -------- ---- - = rhone. .... f�" <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑I Trailer Court ❑ Motel ❑ Other ❑ <br /> s <br /> Number of living units: ..-l_ Number of bedrooms a2:- Number of baths --./ Lot size ----�®---X12-90-I-------------------- <br /> Water Supply: ' Public system ' Community system ❑ Private ❑ Depthlto Water Table _ft <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobep Hardpan ❑ <br /> Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)"`""""' <br /> fi � <br /> Septic Tank: Distance from nearest well Distance from foundation-.1a�---------Material-- ---------------------------- <br /> - <br /> .�.___.__---_.----------- <br /> No. of compartments....._..____.____Size--U'�>S`�--...-___I_iqu-d depth...-f�_ "..- .-.__Capacrity.. --- <br /> Distance <br /> Distance from nearest well.......-----------Distance from foundation--------------------Distan66 to nearest lot line..............._- ¢ , <br /> Number of lines-----------------------------------Length of each line------------.----------------.Width 7of trench.-----.------,--------------.------ Ste] <br /> Type of filter material--------------------.-----Depth of filter material-----------------------Total length------------------------------- ----.....- <br /> e ,Pit: Distance to nearest well-------------_--------Distance from foundation--------------------Distance to nearest lotdine------ _..-.._._ <br /> Number of pits.--------- ------Lining material-----I----------------Size: Diameter.-----------I----------Depth---- :------------------------. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------- -._.Lining <br /> material-_.__.....-._°4_r_1...._............. <br /> qud'Ca'Capacity gals.Size: Diameter....- °..... .. ...............De Depth ........ _-. . - ---------------- L' i . <br /> j <br /> Privy: Distance from nearest weUl..-.__— .--------------.:J------.--.---.Distance from nearest.buildin = f l <br /> ❑ Distance to nearest lot line---- ----------- - --------------- ----------------- --- -------'----------------------------------------------r- ---.a ----- + <br /> F Remodeling and/or repairing (describe)_______________ __ _ <br /> z <br /> - <br /> ------- - ------- ----------------------------- <br /> -. <br /> �-- Jam'--- -----• - --- - -- - <br /> t" i ! <br /> I hereby certify that 1 have prepared this'application and that the work will be done in accordance with San Joaquin County ; <br /> ordinances&Sfate411aws, d,rules d r ulations of the San Joaquin Local Health District. <br /> 'I (Owner�7 = and/or Contractor) <br /> (Signed) <br /> B <br /> Tit ---- <br /> ------­­ <br /> ----- --- --------- <br /> (Plot plan, showing size of lot, location of system in gelation to we , buildings, etc., can be placed anreverse side). <br /> f FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ( � ----------- DATE--------K - ---------------------------------------- <br /> REVIEWED BY-------------------------- ---------- ----------------= { DATE—-- <br /> --------------------------------------- <br /> BUILDING PERMIT ISSUED------•------------------------- .0 # DATE <br /> ------------------------------------- ----------------------- -------- <br /> Alterations <br /> -------------------------------- <br /> Alterations and/or recommendations---------------- ----------- -- -- ------------I----•------------------------ - 3 <br /> 1 <br /> ---------- ---------------------------------------------- ---- --------- - ---------------------------------------------- -------------------------•---- -----------------------------' <br /> t <br /> -------------------- <br /> I <br /> FINAL INSPECTION BY:....__ ,�/---- ------------------------------- <br /> Date............ <br /> ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. �� '300 West Oak Street 4 124 Sycamore Street 205 West 91h Street <br /> an <br /> Stockton,California Lodi,California Mteca,California.4 Tracy,California <br /> F.P.CC. w I <br />