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FOR OFFICE USE: <br />------------------------------------------------------- <br />--------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. �- i <br />-------------------- ------------------------------------ (Complete in Duplicate) <br /> This Permit Expires I Year From Date Issued �ro Date Issued //,-_,2 - 7 <br /> eo <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work ereinclescribed. <br /> This application.is madeTin,compliance with County Ordinance N/p. 549. 1I j( <br /> 5'JOB ADDRESS AND(LO ATI ..- Z- l�-vrvk <br /> 1 .YtC'� _- -e( i �� = <br /> 9 /� , ... --�-7.. <br /> Owners Name_ j'_L+Yl f e `'S ,A � ,� Phone_ ?�r <br /> ff <br /> Address----------------------- �_�K -- --------------- <br /> V .. <br /> Contractors Nam �' r' '1 al's---- -�G.1afE�'�" �_---- .e--------- = Phone-_5671-n— <br /> e � --- <br /> Installation will serve: Residence [ff Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---1_ Number of bedrooms ' _ Number o baths ---J_ Lot size ----------------------------------------------------------- <br /> Wafer Supply: Public system ❑ Community system ❑ Private Number <br /> t Water Table -------- ft. <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 �New Construction: Yes E­No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> —'(No sepfic'fankor Cesspool permitted if,public sewer.is available within 200 feet.) �.�------- -�p ` <br /> Septic Tank: Distance from nearest we0 f <br /> __----Distance om foundation___r__0_____-Material-_ _ _ -----------_____ <br /> __ <br /> of compartments--_ �...Size------ - U-------------Liquid depth------------------------ -Ca acit - ------------- <br /> No. __ <br /> , <br /> Disposal Field: Distance from nearest welllACr.._.Distance from foundation___.- Distance to nearest lot I- <br /> Q/ Length of each line_ L3� Width of trench____' -- __ <br /> Number of lines_____________ g -------- - f <br /> Type of filter material__. _ `'`�Y'L of filter material_____f _.__ ._._Total length---------- __ -------------------- <br /> Depth <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 /> 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 /> ----------------------- --------------•----- ------------------------------------------------ <br /> Remodelingand/or repairing (describe):-------------------- ---------- -- -- --------------------------------------------------------------------------------------------------------------- <br />` ------------------------------------------------------------------------------------------------------------------------------- ------------------ -- <br /> ---- -------------------------------------- ---------------•------------------------------------------------------------------------------------------------------------------------------------- --------- <br /> ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> I hereby cert <br /> ordinances, State law r &Mb r fj6Ma, i @%e San Joaquin Local Health Disfrict. <br /> (Signed) <br /> Ail S. SACRAK4ENT ST. <br /> kp ; A Qf? - caner and/or Contractor)�...� <br /> jj -- - <br /> (Plot plan, showing size of lot, locafion of system i�tesla t�n f we s, etc., can be placed on reverse side). <br /> FOR ARTMEN ,, E 01—1 r <br /> APPLICATION ACCEPTED BY----. - �? ---------------------------------------------------- DATE__ _ _ r __�lP_T---------------- <br /> REVIEWED BY------------------------- DATE <br /> -- ----------------------------------------------------------------- <br /> tBUILDING PERMIT ISSUED.------------------------------------------------------- --•--_---------- --------------------------- DATE------------------------ - <br /> Alterationsand/or recommendations:-------------------------------------------------------- ---------------------------------------------------------------------------------------------------- <br /> ------- •------------------ -- ------------------ --- .----- --------------------- <br /> l ,ti - zv-G <br /> FINAL INSPECTION BY: - r - ----------- Date- --- ------------- <br /> /SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1641 E.Ha:ellon Ave. 300 West Oak Street Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Clew,California Tracy,California <br />