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FOR OFFICE USE 3 \ <br /> ------------------!'i <br /> APPLICATION FOR SANITATION PERMIT. Permit No. _fr'. . <br /> (Complete in Duplicate) <br /> _ <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 County Ordinance No. 549. <br /> JOB ADDRESS AND L CATION. . - "? .... .' - --------------- <br /> Owner's Name-------- - --------_--- --------- --- ------- - Phone---------------------------------•-- <br /> -- ---------- ----- l y � - -•--tS`vr ��u•-f_..?� <br /> Address --- " »� <br /> Contractor's Name---- -- -- --- -- ----- - -- --- -------- --- --- -- ------ - -------- - -------------- S%f(,t, <br /> Installation will serve: Residence A ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/_ dumber of bedrooms -,*7-. Number of baths.R!Z- Lot size ----���1.-.-1��i----------------_---- <br /> Water Supply: Public system E] Community system J� Private ❑ Qepth to Water Table t22Q ft <br /> i Character of soil to a depth of 3 feet- Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan <br /> P ❑ ❑ Y ❑ Y � Y ❑ ❑ ❑ <br /> [ Previous Application Made: ;(If yes,date------------------- ) No New Construction: Yes JANo ❑ FNA/VA: Yes or 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- Q.......Qistance from fours tion__ �__.- --_- Material ...... ....... ------........ ... ........... <br /> t SS .....--Liquid de th....;'. ---- -------.Ca acit � do6'�,L <br /> No. of compartments-..__....�.____..-..Size ..--. q p. p y .- .....-.. <br /> Disposal Field: Distance,from nearest well_ Distance from foundation:-.�'..' _..Distance to nearest lot line---is-----.---.. <br /> Number of lines.__.._ Length of eadkne..�Q_�..-......Width of trench-.� �7---------------- <br /> Type of filter,material- Depth of filter material--- ..._� g pz..�.. <br /> -- -- ��_ :-....Total length a <br /> Seepage Pit: Distance to nearest well .....................Distance from foundation--------.-----------Distance to nearest lot line----------------- <br /> ❑ Number of pits--- ------------------Lining material---------------------- Size: Diameter----------------------- Depth--------------------------------- <br /> t Cesspool: D) stance from nearest well ................Distance from foundation------------.---- -.Lining material__._t.....--------. --.---.----------. <br /> ❑ Size: Diameter- -- -------------- ------------..Depth------ --------- ---------------- --------- ------- Liquid Capaci.t.Y- -------gals. 1 <br /> I Priv Distance from nearest well........................... . Distance from nearest building <br /> ❑ Distance to nearest lot line ---------=--------------------- ----------------------------------------------=------------------------------------------------------------ <br /> Remodeling and/or repairing (describe)-------------------------------------- --------------•---•---------------------- ------------------------- ---------------------- ------------------------ <br /> F ------------------------------•--- .------------..-._....-.-.-------------.-.-..----------------------........---------------------------------------------...---.-......-----....----------------------------..._-----.-. <br /> S <br /> L ..-_-...._-......-_..................................__.....--.........._.....__..-_.._........._................__...................._..-------------------------- -7------------------------- ------------- <br /> r <br /> .......... .------------------.-----......................-.-------------....------...---------....-...-"---------.-....---------_.-.....-......-..-_........--.-...-.-...--.-..._.-......----..-------......-... .... <br /> 1 i <br /> I'hereby certify that Lhave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rule an regulations of the S Joaquin Local H alth District. <br /> Owner and/or ontractor <br /> (Signed) <br /> BY:--------------- ------i---------- --- ---- - ------------------- ------------------------------------ -(Title)------------- - - -- ........ ------------ ------------------ <br /> (Plot plan, showing size of lot, ocation 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 /> iBUILDING PERMIT ISSUED-------- --- -- - ------ ----------------- -------------------------------X------------------ ----- DATE------- -------------- -------------------------------------- <br /> Alterations and/or recommendations-------------------- -------------- ............ --- ---------------------------------------- ------------------- ---------•---•---------- ----------- <br /> . <br /> ---•- ---. ---- --------- --- ------ ------- -- ----- a-- - ---- ----0---------------------®�-- -- ---:b----- - ------- -----•-- -- ----------------- - -- <br /> : ,- .�. ... �� ...- •---•------------------- <br /> :j�-�Q::--- ----- - -- ;:,:::___ -=:--==_-:-_::: -------- _ -------.---------------------- <br /> l � <br /> FINAL INSPECTION BY:..- --------------------- Date-. ----------------------------------------- <br /> N JOAQUIN LOCAL HEALTH'DISTRICT <br /> + 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 21%1.67 Vanguard Press <br /> F <br />