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FOR OFFICE USE: - <br /> ------- ----------------------- <br /> ----------------------------- --------------- APPLICATION FOR SANITATION PERMIT Permit No. 4;1 <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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_ _C _- 20 -'/�/�J-l--__�7'_.�J� �CT�- --- <br /> .. <br /> Owner's Name__e �i-_.. u.�3 . / ------------------------------------------------- --- -- --------------------------------------- Phone------------------------------------ <br /> Add ress----------------------- <br /> --- - -------- ------ <br /> Contractor's Name---- ------1r-..� ---- ----------------------------------------------------------------------------- Phone- <br /> Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -Pv-- Number of baths _/--- Lot size ---------_____---__--------------------------------------- <br /> Water Supply: Public system ❑ Community system N Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand N 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: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--.s-_.--Distance from foundation--.147-------- __..__ <br /> ---------------------------- <br /> No. of compartments----- ----._...--.----Size-���w4_&-Liquid depth_��------------ --- Capacity--s 'Q-U-------- \ <br /> Disposal Field: Distance from nearest well____��--Distance from foundation-___46--_----Distance to nearest lot line---6-----.- <br /> 19 Number of lines----_-.-_---�-----------------Length of each line------------ -----------Width of trench----�----------------------.-- <br /> Type of filter material---- .--Depth of filter material---- - -----------Total length----1-0©------------------------- <br /> Seepage Pit: Distance to nearest well--------------- -----Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 0 Number of pits----------------------Lining material--------___--------Size: Diameter--------------.--------Depth-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation...-----------------Lining material-----------.---_._______-_.-.----- <br /> ❑ Size: Diameter--------------------------------------Depth- - - - r------------- - - -----------------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):------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------­.- <br /> ------------------------------------ <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, State laws, and rules nd regulations o the San Joaquin Local Health District. <br /> (Signed) -------------------- --- - -------------- ------------------ -- .(Owner and/or Contractorl <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 /> APPLICATION ACCEPTED B . ----- /�-�-.. ---------------------------------- DATE----J-- �-------- --------------------------- <br /> REVIEWEDBY------- ----------------- - --- ------------ --------------------------------- ---------------------------------------------- DATE--------------------- <br /> BUILDINGPERMIT ISSUED----------- ----------------------------------------- ----------------------------------------------- DATE------ -------------------------- ------------------------ <br /> Alterationsand/or recommendations:------- -- ------- -- --------- ---------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------- -- -------- <br /> --------------------------------------------------------- -------­-------------------------- ----------------------------------------------------------------------------------------- ---- ---------------------------- <br /> ----------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- --------- ---------- ----------------- <br /> ----------------- --------------------------- -- --------- ------------------------ ------------------------------------------------------------ ----------------------------------------- ------ -------------------------- <br /> FINAL INSPECTION Date--.- -- <br /> y/c' -. - <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 />