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FOR OFFICE USE: <br /> ___--___----------------- _, APPLICATION FOUR SANITATION PERMIT Permit No. <br /> %/r � (Complete-in Duplicate) <br /> ----- --__. ------------ -------------- ----- --- Date Issued �-�-----�., <br /> -_.__---_-__._ -__.___----- ----- --------------- This Permit Expires 1 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 <br /> County Ordinance No. 549. <br /> JOB ADDRESS ANND�LOCATION /�. -------- -- /� ------------------------------------------------------------------------------------ <br /> Owner's Name---- T , 9 --- Phone---------------- ------------------- <br /> Address - <br /> -- ---------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name---.A-. - ( S --------------- Phone................................... <br /> ------------------ ----------------------------------- ------- -------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ _Other ❑ <br /> Number of living units: _/---.- Number of bedrooms __� Number of baths-1----- Lot size -----7_?t.___- C__3_ . -_______________--_ <br /> Water Supply: Public system E4—Community system ❑ Private ❑ Depth to Water Table 4.pft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ San y Loam E] Clay Loam ❑ Clay E] Adobejf"'`Hardpan C]Previous Application Made: (If yes,date_-...____--_._._. ) No New Construction: Yes o ❑ FHA/VA: Yes n- No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 100 feet.) <br /> Septic T Distance from nearest well'._" ----------Distance from foundation,/Q--------------Material ----6__oZ_ c:3 � ................ <br /> i �� j <br /> No. of compartments.. . _._._._.__Size__ X �G <br /> .�" __`T___:___Liquid d _ uepth_______ _____ _____ .Capaty_.._ `---_---U_ <br /> Disposal Field: Distance from nearest well---...._....Distance from foundati n__AQ--`.---._....Distance to nearest lot line-_6h____'.... <br /> Number of lines ----I__-_-___-____.._--__-.-.-Length of each line.- __ _____..-----------Width of trench._%Z_ _ ------------- <br /> Type of filter material__r`1_?t*C_!�-___-Depth of filter material....,l8-----k--( <br /> ------- <br /> length--------- a'__---__-----.-._-__---- <br /> Seepage Pit: Distance to nearest well-----..".'-----------Distance fxnrfoundation---��°_-_-_-_.-.Distance to nearest..ISQ�t��line-,5��---- <br /> Number of pits--------- ___.__-.__Lining material------ Size: Diameter.___.. _.Z......Depth___.:6*.�,_------------------ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation----------------- _.Lining material-----.------------------------_....... <br /> ❑ Size: Diameter- -- -------------- ----------------Depth----- --------- ------------------------ ----------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 /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------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 rule and gulations San Joaquin Local Health District. <br /> Si ned <br /> ( 9 )------------------------- ........ <br /> - - - - - ----------------------- - (Owner and/or Contractor) <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 BY - - `--------------------- ------ DATE--- <br /> REVIEWEDBY-------------------------------------------------------------------------------------------------------- ------------ DATE--------------------------------------------- <br /> BUILDING PERMIT ISSUED---------- ------------------------------------------------------------- ----------------------- DATE----------------------------------------- <br /> Alterations and/or recommendations:------------------------------ ------------------- -•---------..----------------------------------------------------•----------------•-----......----------- <br /> -•------------------- ------ --------------­---- ----------------------------------- ------------------------------ ---- ----------------- •---•--------------------•- -•---------•-----•---- <br /> -----------------• ------- ------------------ ---------•--------- ------ ---------------- -----------------------------------------------•----------------------•--- ---------------------•-•-•----•--- ----•--- <br /> ---------- ------- ----------- ------ --- ------------•------- -----•----- ----------------------------------- <br /> FINAL INSPECTION BY:.- ....... -'' 1.1 ----------------- Date.....-_..------------ ---_`_f(:_�-- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Celifornja Lodi. California Manteca,California Tray,Ealifosnia <br /> E.H.9 2M 1.67 Vanguard Press <br />