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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .__1 �.._-._ <br /> -------- -- <br /> (Complete in Duplicate) 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 LOCCA�ATIIION.I^- ol.t I,"a.!-._?h- - _____ 0L_____ - ------ <br /> Owner's Name-_,_0_.- -_[+t 44V_X a-------------- f ------------------------- <br /> Address <br /> ! p Phone <br /> yy��,,cc n --- -- ------------------------------------ <br /> Owner's Name_4_,_0_.__ra44V_XA <br /> ..........0.7�t----/ -• ' •' GG <br /> Contractor's Name T'.5------------------------------------------------ -------- •--- Phone---- ------------------------------ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ________ _ ____ ._-_-_----___---_----------..--._ <br /> Water Supply:. Public system ❑ Community system ❑ Private []Depth to Water Table e1-oot. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan E <br /> Previous Application Made: (If yes,date--------- ----------) No Ug' New Construction: YesL�J­No ❑ FHA/VA: Yes ❑ No ®� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y� <br /> Septic Tank: Distance from nearest well± 4_ Distance from found ._ation -.__-.__._-Material_��' '! NO <br /> l -------------------DWI" ------- <br /> a -r <br /> ---------------Capcit ---�.2_gpc--- <br /> Disposal Field: Distance from nearest well S`D_-------Distance from foundation-AV" ----------Distance to nearest lot line_ <br /> [I� Number of lines----/-----------------------------Length of each line__10--------------------Width of trench.---v?_.7I_:`------------------- <br /> Type of filter mate rial�71 .QlrA----.---Depth of filter material---7-4.1.-'_.___.__Total length---------- ----------------------- <br /> Seepage Pit: Distance to nearest well---/GQ__`--------Distance from foundation__-----_. Distance to nearest lot line-- a-' <br /> [4/ Number of pits------4---------------Lining material___RP.5 44 - Size: Diameter----33............Depth-._._.. _SSS'--..------.-- <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 /> Remodelingand/or repairing (describe):---------------........-•------•------------------------------------------------------------------------------------------------------------------------- <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, ndnrules and guI ions o the San Joaquin Local Health District. <br /> (Signed) L -.-----------------------------------------------------------------(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 /> BUILDINGPERMIT ISSUED------------------------------------------------- ---------------------------------------------------- DATE--------------------------------------.---------------------- <br /> Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------- ---------------------------- <br /> ----------------------------------------------------------------------------------------------------- ----------------------------------------------------- --------------------------------------•-------------------------- <br /> ------------------------------------ <br /> ----------------------------------- ------------------------- ------------- --•-------------------- ------•------... ------------------------------------------------------------------------------------------------------------------------ --------- <br /> -------------------------------------------------- <br /> ---------------------------------------------------------- -------------------------------...--------•--- ------------------------------------------------------------------------------------------------ ------------------------- <br /> ----------------------------------------- ------ ------------------------------------------------------------------ ---------- ----------------------------------------------------------------- -------------------------- <br /> FINAL INSPECTION BY: - -- --- -- - --- Date_..// _T....... --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haseiton Ave. 300 West Oak Street 124 Sycamore Street 265 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r.p-co- <br />