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FOR OFFICE-USE: a - <br /> ------------------------------------ <br /> °PPLICATION FOR SANITATION PERMIT Permit No. .�.p <br /> ----------------- <br /> -- <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 comqjiance with County Ordinance No. 549. r►�_ <br /> LoT # � <br /> JOB ADDRESS AND LOCKaRmaiq <br /> ON_-----/---'O-ff___��----I----_L 1R_�''�_�T_____--.v.--7--- ._._�I�_C�WZ&......_69B/ -.._6 COP <br /> Owner's Name------------------- J �.! ---------------------------------- Phone----------------------------------- <br /> ------------ --- - ------------------------------------- <br /> Address---------3-16-Y---------.�`ENYO—N--------pRl\-C 5AN T�------•.C1-A.R�---j1-------09� ..F <br /> Contractor's Name----CWM- -R-------- --------------------- -------------------------------- --------------------------------------------.- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel I-] OtherE]Number of living units: --I----- Number of bedrooms _ _'____ Number of baths -_I____ Lot size __ ----- ____�.7�.......................... <br /> Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand Ell"Gravel ❑ San y Loam ❑ Clay Loam ❑ Clay [-] Adobe E] Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No New 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.) J <br /> Septic T nk: Distance from nearest well.0°__�___-Distance from foundation_.---�Q_-_-._.Material._CQK�-K�T�____._____. F/ <br /> No. of compartments---------L'_�-----------Size-101Xha.-X-,?�----_--Liquid depth____�0-2Capacity-__ <br /> Disposal Field: Distance from nearest well_-CJV-Distance from. foundation-----/Q--------Distance to nearest lot line... �. <br /> Number of lines------------il. - Length of each line_.------lo-.----_.____.Width of trench------ __�___._---_-_--- <br /> Type of filter material---- (1�x____Depth of filter material-_l9_ .------Total length---_------S!p---------------------- <br /> Seepage Pit: Distance to nearest well--------------.-------Distance from foundation--------------------Distance to nearest lot line-----.--------.-- ,A <br /> ❑ Number of pits_____________________Lining material _-_-__----- -------Size: Diameter---------.-------------Depth__________________--.-_____-_- <br /> Cesspool: Distance from nearest well---_------_------Distance from foundation------------------- material--------------.____.__--_--.--__-__-_. <br /> ❑ Size: Diameter- ------------------ ----------------Depth----------------------------- ------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____________----_---____-________- 1' <br /> ❑ Distance to nearest lot line--------------------------------------------- --------------------------------------------------------------------------------------------_ <br /> Ado <br /> Remodelingand/or repairing (describe)------ --------------------------------------------------------------------•----•------------------------------•------------------ ••---------------- 0 <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 r gulations of the San Joaquin Local Health District. <br /> (Signed)----------- -t-l" --- - -- ----------- <br /> ------------------------------------------------------------------(Owner and/or Contractor) <br /> By:---------------------------------------------- ----------------- -----------------------------------------------------------------(Ti+le)------------------- ------- ----------------- --- ------------- <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- ---T_K-©----------------------------------------- ------------------------ DATE--------/~-•.--Zl.— ---------------- <br /> REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------... DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- --------------------- DATE.------------------------------------------- --------------- <br /> Alterations and/or recommendations:------------------------------------ -------------------------------------------------------------------------------------------------------------- <br /> -------------------- --------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- <br /> ---------- ------------------------------------------------------------------ ----------------------- ------------------ ----------- ------------------------------------------------------•--------------------- <br /> ------------------------- ------ ------- -------------- ---- ------------- ---- ---------------------------- --------------------------------------------------------------- ------ <br /> ----------- --------- ------------------------------ ------- - ------------- ------ <br /> FINAL INSPEC --- - �4-- ------- Date--------- .- 27-------- ------------------------------------- <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 /> F.P.CO. <br />