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�FO�OFFICE USE: f <br /> -f� _ J------------------- - ­-•-A41_ICATION FOR SANITATION PERMIT Permit No. _._. <br /> --------------- ----------- -------------------- ----- (Complete in Duplicate) <br /> Date Issued ____ <br /> ------------------------------------ -------------------- This Permit Expires i 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 /> f <br /> JOB ADDRESS AND LOCATION--0----_ ! ? . ,! ------ <br /> Owner's Name.-------- / <br /> - ------ - - - --------.,-----=----------------------------- - -----------..------------------------------------------- Phone--------------------- <br /> o <br /> Address ! ���--- - -- -. --sl�f ------••-•-•--•------------ ---------------•--------------•-------------------------------- --_---•---••----•---- ...... <br /> Contractor's Name------------ - - - -, ---------------------------------------------------------- ------ Phone------•-----------_---•--------•-- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Frailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._ __ Number of bedrooms S. Number of baths,..-:—?-- Lot size 14AZZ1� ----------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private grIDepth to Water Table Aw tt" <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Zj'01C6ay E❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ® New Construction: Yes �o ❑ FHA/VA: Yes R40" 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---dw---- Distance from foundation--_1a--------- <br /> Material__&4--��" .... ................ <br /> No. of compartments----A------------- Size-�X�_0f�--_--.---Liquid dep`h___--���..----__--Capacity--��-�s_-- <br /> k <br />. .--Distance from'foundation-___ -__---.Distance to nearest lot <br /> Disposal Field: Distance from nearest well_- ..Q. <br /> ®/ Number of lines-------A---- --__-Length of each line--- � <br /> ----- -----------width of trench.-2---------------------------- <br /> Type <br /> -------�--------- -- - <br /> ' Type of filter material-� epth of filter material--_,eo ------.-Total length----`e��----......---_-..--_- <br /> Seepage Pit: Distance to nearest qwell-_. -- Distance from foundation----1 r.�..--.pist n�e to nearest lot line._✓_-._.. <br /> [L]� Number of pits-----A-----------Lining material-�t1�--Size: Diameter_��-.--..----Depth,-;9-t0___/ ,r��- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------.------.--------------.--. <br /> ❑ Size: Diameter--------------------------------------Depth--------------------------------------:,ti----;,-`Liquid Capacity-.--------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------_-.- <br /> ❑ Distance to nearest lot 1ine----------------- ---- --------------------•-_-•-----=--------------------------------------------------------------• --------------------- <br /> Remodeling <br /> ---------- --------Remodeling and/or repairing (describe):__-114 - <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)•---------' •' ---- ----------------- -------- -- --------------------------------------------------('GwrwP-&W/or Contractor) <br /> --(Plot plan, showing size-of lot, location'of:syste relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- -- - --- ----- -- ---- 1+` ------------------------------------- DATE-� , `/ ----------------- <br /> REVIEWED BY--------------------• • - <br /> --- ---------------- ------------------------------------------------------------------------------- DATE_-----•---•--/------- -- <br /> BUILDING PERMIT ISSUED----.-------- DAT ---------------------- <br /> � - ' - - { <br /> -___Alterations anor recommendation ----.-__-"--'.--- -__--_ <br /> ----------- ----- ----- -----_ -- <br /> ----------- _-_ ""-- -- -__- ._••---.""-• ---------------------- ""'-.- ------------"_.•__-L------_....--•_--_--__--_-•------•----------------------.-------------------.--------------------------------- <br /> --------------------------------------------------------------"--------------------------------"-"-"--------------------------------------"'""-""-"...--------"----------------------------....._----------------"------'----- <br /> -----------------------•---__-------_...-.-.__-....-------.-------------...----.....-.--.--.--...-..-.-.-.....-.-----•---------..----.--.-------..-----•_•-.-.-_------------_--_-..-.----.-...-----.-------------------------- <br /> FINAL INSPECTION BY:..A/ r3OO <br /> � ------ Date---------------�--------------� - ---- ----- -------------------- <br /> JOAQUIN LOCAL HEALTH DISTRICT f <br /> 1601 E.Hazolton Ave. st Oak Street 124 Sycomore'Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Es 9 RFjviSED B-59 3M 3-'63 F.P.CD. <br /> t <br />