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FOROFFICE USE: <br /> .. -- APPLICATION_­FOR SANITATION PERMIT Permit No. ._��sJ�... <br /> ------------------------ ------ ------- ------ (Complete in Duplicate) / <br /> Date Issued <br /> .............. This Permit Expires 1 Year From Date Issued <br /> O2-foo -D2— <br /> Application is hereby made fo 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. �j <br /> J.O`1 D S'. r�7Q Q—� 1 ► --- -- f , ��--- <br /> JOB ADDRESS AND LOC TION. .---.--_- ------ - ---- - ----- --- ------- --- - - ----- <br /> Owner's Name ! --------[1 - Phone <br /> - --- ------------- --- ---- - <br /> Address.......... .. . ��--- - -- --------- <br /> - <br /> Contractor's Name--- --------1 ------- Phone----------------------------------- <br /> Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms __-r__- Number of baths __V__ +Lot size __-__-Q _•______________________ <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 Loamg Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dote_------- --------- J No ❑� New Construction: Yes DR No ❑ FHA/VA: Yes ❑ No ❑ �+ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: or <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Distance from nearest well-------- Distance f om foundation__.___/0-------Material _ ___._ __._______________________ <br /> No. of compartments_.. -9------- -----------Size----- Q ®-y -.---Liquid depth-------- - - --- -Capacity.---F0 p_ - <br /> T a. O d ! [� o <br /> Disposal F' Distance from near -_- <br /> st w 11 -1 from foundation___-_! _ <br /> ! _-_____-Distance to nearest lot line______ ' rD <br /> Number of fines__ P�� _. 44 <br /> ----Length of each <br /> line__A ---� o--- Width of trench------ <br /> Type of filter material_ fa% -__-___-_Depth of filter material�_ x� --�Total Een th_____._.__1-,____Q_.?___-�__ <br /> _____@______._ <br /> Seepage <br /> Pit: Distance to nearest welt----- ----------------Distance from foundation--------------------Distance to nearest lot line-_-____-__--__ <br /> ❑ Number of pits----------------------Lining material----- - ------------Size: Diameter-----------------------Dept h--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation...-----------------Lining material-------.----------------------------- <br /> Size: Diameter----- --------------- ----------------De th----------------------------- <br /> ❑ p ----------------------------- ------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------------------------------------------- --Distance from nearest building.-_-_.___.-______________________-___. <br /> ❑ Distance to nearest lot line- --- --------------------------- --------- ------------------------------------------------- -- ------------------------------------------ <br /> Remodeling <br /> ----- -------------- ------- <br /> Remodeling and/or repairing (describe):__X�_ _ - " ......... --------------------------- --------- ------_.-__. <br /> --- - --------- ---- --------- ---------- --- ---------- -- -.-- r------ <br /> --- -- -o Q 1 -- -------- °--- <br /> ------- - , ,,P ` �` --------------------- <br /> I hereby cern �fhat e prepared this applicati idand and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law and rules and regul 'ons of fh an Joaquin Local Health District. <br /> (Signed) - ------- ----------------------- -----------------------(Owner and/or Contractor) <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------- <br /> (Plot <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 /> ----------- <br /> REVIEWEDBY---- --------------------- - - ------ ----------- --------------- ---------•--- DATE--.-. -- ------ ------------- -------------- <br /> BUILDING PERMIT ISSUED-_------------------------------- ----------------- ------------------------ ----------------• DATE.-------- ----------------------------- --------------------- <br /> Alterations and/or recommendations------ --------------------- -------------------------------•-------------------------------------------------•--------------------------------.. <br /> - -------------------------------------__------- --------------------------------------- -------------- -- ------ <br /> ------------------------------------------------------------------------ :. <br /> ----------------------------------------------- ------------------------ <br /> FINAL INSPECTION ._ .. Date <br /> _ SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 V <br /> Stockton,California Lodi,California t Manteca,California Tr,�; <br /> F.P.CC. r <br />