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FOR OFFICE USE: \ <br /> APPLICATION FOR SANITATION PERMIT Permit No. . .- ____S�.__- <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 fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br />` JOB ADDRESS AW LOCATION------_L--7_5_40-------------- ---------------- ' J <br /> --------------------------- <br /> --- <br /> q � �/4 <br /> Owner's Name----- / ------ -------- ---------- Phone--- __�V _ _ <br /> - •-• � 1 <br /> Address ' '------.mo i --- ---- ----•-- ---------------------------- ---- 4Z----_64�rL----------------- ----------------`-------_______-----••---•- <br /> Contractor's Name--------• ------ - r --- ----- ----------- ? ---------- -------------------•--- Phone..'��1�1�_� <br /> Installation will serve: Residence 0 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 Depti-i to Water Tablejp_ ft V <br /> Y } <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe t2r Hardpan ❑ <br /> Previols Application Made: (If yes,date__........-, I No x New Construction: Yes No ❑ 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.) f v <br /> , <br /> septic, Distance Distance from nearest well___�G--.--_Distance from foundation----�v__----- Mater al _i�/r .. 1- /n' <br /> No. of compartments_.. �K- q p p y- <br /> ---------...Size 5`x Vic_ Li uid de �h '� Ca acit d__ ----- <br /> Disposal Field: Distance from nearest well__.D..--_-_Distance from foundation__g7_0___._...Distance to nearest lot line___.__ <br /> Numberlof lines-------- __________ __j ... Length of each line_: -------------------Width of trench..__ <br /> Type of filter material� ✓_7` .,.--Depth of filter material----11_F .._---- length--------------------.- 42-------- <br /> 6 Seepa a Pit: Distance to nearest well_ <br /> 1f ---Distanco fotndation__l/4-------Distant a to nearest lot line_J_ <br /> _... <br /> Number of pits. <br /> __: - Depth- <br /> ---------- Lining material_ Size: Diameter _ <br /> ' <br /> r <br /> i Cesspool: Distance from nearest well ------ .--Distance from foundation____............ ..Lining material---------------------------------- <br /> ❑° Size: Diameter- -- --------- ----- ------------- Depth --T---------------------------Liquid Capacity- ------------------------gals. <br /> Privy:' Distance from nearest well ___-----------------------______�._Dis+ance from nearest building.___._..______..___._ <br /> ❑ Distance to nearest lot line ..-------------------___ 1 ---------------------------------------------- <br /> Remodeling <br /> - <br /> Remodeling-and/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, Stat laws, and ,rules and �Iarfionsthe SJoaquin Local Health District. <br /> - -- ------ - ----------- - ------ .._..._._ r Cont(Signed)------------ and/or tort <br /> TI#le W <br /> By:------------------------------------------------------------ - ( ' 1 <br /> E (Plot plan, showing size of lot, location of system in relation to w buildings, etc., can be placed on reverse side). <br /> i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- -- ---r.--U ----- ---- -- ---------------------------------------- DATE------ ------- <br /> REVIEWEDBY---------------------- _------------------------------------------------ ------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------- ----------------- ----------------------------------------------------- -- ------------- DATE- ---------------------------- <br /> Aiterations and/or recommendations:---------------- -------------------------- -- - -----------------------------------------------.--------------------- --- ------------------------------------- <br /> --------- - -------------------------------------------------------- - ---- - - ------------------------------------------------ -------- -- - -------------------------------------------------------------------------- <br /> ...---- ---------=----- ---------------------------- - - <br /> -------------------------------- ....................... ------- ------- ---------- - �.---------- ------------ -------------------------------- ------------------------- ---------------- ---------- <br /> ..----.---`.............- ------------­­ - ------------------ ------------t - ------------------------------------------------------ <br /> -------- -- - ---- --------- ------------------------- <br /> I <br /> FINAL INSPECTION BY:.....- - Date -�. .--------------------- -- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7601 E.Haxelton Ave. 300 Wast Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> ! E.H.9 2M 3-67 Vanguard Press <br />