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FOR OFFICE USE: <br /> -------------------------------- --------------- <br /> -- APPLICATION FOR SANITATION PERMIT Permit No. .�.. .- D. <br /> - ------ -------------------------------- ----- ... (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 ith County Ordinance No. 549. "-C A <br /> JOB ADDRESS AND LOCAJZ <br /> N--$1-v�----f I R�DRr---_.W ' 1 h�/ /7(7 <br /> Owner's Name -------- '� �-}! _RRISt- -------- - --------....__------------ ---------------------- Pho e-----•-----------------------...---- <br /> p <br /> Address--------------------Z__.3-�-�.. ........�--------hive&- -------....R--I>.-'------------------- .................................... <br /> Contractor's Name---tni._ jv_rt s------------------------•-•------------------------------•- ---•--- ------------------------------ ------------ Phone------ _---------------------•---.- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ nMotel ❑ Other El <br /> Number of living units: --I----- Number of bedrooms =Number of baths_ _._ Lot size __/7 C-I�jF_Ac.f =------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to VV r Tableft <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 Construction: Yes ❑ No �A/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-.---------------Distance from foundation-------------------Material -----------.-.------.---_--..____..._.-__-__-. <br /> j IA ;C-- No. of compartments--------• ----------------Size---------------•--- -----------Liquid depth--------- ------- ------- Capacity----------------------- <br /> Disposal Field: Distance from nearest well--.-.........._Distance from foundation--------------------Distance to nearest lot line___.._-----__._.. <br /> S T/^(C Number of lines------------.-------------------.-Length of each line_ ---------------------------Width of trench---------._-__.____-._.-.--_----.. \ <br /> Type of filter material-------------------------Depth of filter material--------------.--------Total length----.-----------------.________-___-_-__-- <br /> Seepage Pit: r Distance to nearest well-----.-5_-Com'_------Distance from foundation..-C.._..._�_r..Djstance to nearest lot line_. ------- <br /> Number of pits---.__. _._--___._Lining material:R�C_ -_-- Size: Diameter--T- __.._.. _ p 4__�__ <br /> ,' --- Depth ------------ <br /> Cesspool: Distance from nearest well .-.-------------Distance from foundation----------------- --Lining rr>aterial---------_--_.__._.-_____„_......... <br /> . <br /> El Size: Diameter- -- ------- - ----------------Depth------- ------ -- ----- -------- -------.Liquid Capacity------------------------=gals. <br /> Privy: Distance from nearest well--------------------.------------------ .__._Distance from nearest building.-_-__;--_- ........_-------.__-.-. <br /> ❑ Distance to'neares# lot lure -----------------------------------_--------------------------•--------------------------------- <br /> Remodeling and/or repairing (describe):----- ----------------------•-----------------•-------- ------ <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 and regulations of the San Joaquin Local Health District. , <br /> (Signed)--------- -----(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----------'S------!'4- <br /> REVIEWEDBY-------------------------- ------------------ -_----- ---------- --------- ------------------------- ------------------------- DATE <br /> BUILDING PERMIT ISSUED------------------------------- -------------- ------------------------------------ --------- DATE--------------------------------------- <br /> Alterationsand/or recommendations:------- --------- --------------•------- ------------------------------------------------••-----•-- -----------------------------------------7------------ <br /> ------ --------------------- -------------------------•---4--------------------------- ...... ------------------------------------ <br /> ---------------------- <br /> ----------•------•--------•--•------------------- ----- --- ---- - -- --- --- - <br /> FINAL INSP —BYi- �' --�- Date--------------- ( 7-y .......6... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />