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FOR OFFICE USE: 4- '' ` z <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ------ <br /> ---------------------- ­------------------------------ (Complete in Duplicate) _ <br /> Da+e Issued l__a-l___��__ <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 complian e with County Ordinance No. 549. SCALON <br /> I <br /> 5 F <br /> JOB ADDRESS AND LOCATION--_-- -----Sr D:l�----"!1,.1_VER._.._15�D-7 � ----saNi—A------Ft�L— <br /> Pcx- -------- R� --- ---------------------- --------------- Phone------------------------------------ <br /> I <br /> Owner's Name Q <br /> Address-----------------p`_Q_,-•----�Q-)<-------------1-77---------------- - -•-•- ---_--- ---------- <br /> Contractor's Name--------D.W1V_I~_FZ1---------------------------------------------------------------------------------- ----------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ /Motel E] Other ❑ <br /> Number of livingunits. __. ---- Number of bedrooms ---•/—Number of 'oaths 4--- Lot size ---- -rte.---------------------------------- <br /> Water <br /> ----`---------------------------Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table . eft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam 0---C�'lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-----------,___..__._) No ;R--New Construction: Yes ❑ No WT`_�HA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No' septic tank or cesspool permitted ifpublics stawer is availablee withvi200 feet:)-" <br /> Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material---__..._____._.--.____-_-______________y'.. "" r <br /> EX[STr NC,— No. of compartments--------------------------Size----------------------------:---Liquid depth--------------------------Capacity----------------------- <br /> �0____.__.Distance to nearest lot line -- <br /> Disposal Field: Distance from nearest well--,5.0-___Distance from foundation_______ <br /> t�T �G-- Number of lines-----------/---------------------Length of each line--- D-----it---.Width of trench_------�`__��.----------T --__-- <br /> d— ADD, Type of filter material---RD-CK----Depth of filter material______ ----------Total length--------------------70-------------- <br /> Seepage Pit: Distance to nearest well----AO-Q-------Distance from foundation_/_- .......Distance to nearest lot line____-- <br /> lz�/ Number of pits- /_____________Lining material__R-.4 __Size: Diameter__ ___. -._- <br /> X 7-----Depth--- - ------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material_____________________________________ <br /> ❑ Size: Diameter----------------------- --- ----------Depth-------------------------- -------------------------Liquid Capacity- --------------------------gals. <br /> I <br /> Privy- Distance from nearest well_________ _____________________________________Distance from nearest building..,._-------.-__-___._____________.------ <br /> ❑ Distance to nearest lot 1ine---------------------------------------------- -------------------------_ ---------------------------- ------------ ---------------------- <br /> Remodeling and/or repairing (describe) ------------------------------ - -------------------------------------------------------- ----------------------- ---------------------------- <br /> ---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------- ---------------- --------- -•-----------------------------------------•--------------------------------------------------------------- --------------I---------------------------------- -------- <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, S a ws, and r s and regulations of the San-Joaquin Local Health District. <br /> (Signed) G ... - ---- ----- - (Owner and/or--C---o-n--t-r--a--c-t--o- <br /> r) <br /> —_ --Tifle ------------ <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-------. i `------------------------------------= DATE 'CZ�3__r�� ------------------------ <br /> REVIEWEDBY---------------------------------------- - ------------------------------------__---------------------------------------- DATE------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------ ---------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:---------------------- - - -----------------------------------------------------------------------------------.----------------------------------------------- <br /> - <br /> ----------------------- ------------------- -------------------------------------- ------------------------------------ --•------------------------•----------------- ---------------------------------------------------- <br /> Date----- - ------- �!� ------•---- <br /> FINAL INSPECTIO - {----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca, California Tracy,California <br /> F.P.0 O. y <br />