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FOR OFFICE USE: <br /> --- - - ------- <br /> .;.d -_:__- ----------- -d--- APPLICATION FOR- SANITATION PERMIT Permit No. �, 7,-9 <br /> --------- ------ -------- ------ ----- --------- [Complete tn'�Dup)icata) <br /> -------------- -- This Permit Expires 1 Year From Date Issued 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 LOCAT! N__!;2_2_ _ r" <br /> �yy� ------------------- ---------------------------------- ------------------_----------- <br /> Owner's Name--///' = # �- ------------------------- Phone <br /> ---------- <br /> Address-----2—&X:--- _-___-- <br /> -- --•---------------•-•--------- --------• -------------------------------------------------------- ---------------------------------------- .. <br /> Contractor's Name-- ------�'--- <br /> I Installation will serve: Residence,[Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ <br /> Other ❑ <br /> Number of living units: --_INumber of bedrooms --- Number of baths __J__ Lot size _.�'_Pf-/d 0.----- <br /> ------------------------------- <br /> Water Supply: Public system [�J•­C�ommunity system ❑ Private ❑ Depth to Water Table _&)ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe E6-'_Hardpan ❑ <br /> Previous Application Made: (If yes,date---- --------) No 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.) <br /> i� <br /> SepticTank: Distance from nearest wel� ancfo�foundatiLiquid <br /> n <br /> No. of compartments..._-_ _._____Size � � f iqu d dePt} .M_4at-e--r-i-a--!-_---.-.---�---_---�Capacity--.--9_7o-.-a-�"---. <br /> Disposal Field- Distance from nearest well---_----------Distance from foundation-_/[_.. <br /> Number of lines--_---/---------------- ------Length of each line-----1A-------------------.Width of trench---2__4-- <br /> Type of filter material-_%? _�t----------Depth of filter material_1-. ----------------- length---+tom------------------------------- I <br /> Seepage Pit: Distance to nearest well Distance from foundation �a ~` +S� f <br /> Num <br /> , -_ - --.---..Distance to nearest lot line----------------- �r $ <br /> ®� Number;af pits:" ...- r3rnater"ial 1.dGl�.: Size: Diameter-------------- --------Depth-------- ------ t <br /> L�n�n <br /> Cesspool: Distance from nearest well---_--.------- ,Distance`from foundation------------------_Lining material----------------___----_- <br /> ❑ Size: Diameter- -------------- <br /> -Depth - ---- ----------Liquid Capacity----------------------------gals. <br /> Privy-, Distance from ne-arest well--..�_--.� --- --------------------- <br /> -- _.......Distance from nearest buildin <br /> - <br /> 5 -------------- <br /> ❑ Distance to nearest lot line. <br /> Remodeling and/or repairing (describe)--------------"---------- ------•------ ---------•-•------------------•-------------- ---•---- <br /> r <br /> ----------- ---------------- --- -- <br /> - -- - -z <br /> -------------------- --- -- --- - ------------------ <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, and rules and. regulations of the San Joaquin Local Health District. <br /> (Signed) ------------------------------------------------ - ----------------- ------- -------------- -(Owner and/or Contractor) <br /> I I i <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 /> t <br /> r FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ----------------------------------------------------------- DATE /ms `s s <br /> REVIEWED -------------- <br /> -- ----------------------------------- ---- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED. ----------------------------- ------ <br /> Alterations and/or recommendations:.: `�'�� r��� � --•--- ------------------------ <br /> --------------------------- ` <br /> - ---�-- -_-..-_ - - _ <br /> ..--- -.-C-- -..- ""------- - --------------- <br /> , aQ ------------ ----- - <br /> - --- --- ----- <br /> FINAL INSPECTION BY:.----- ------ `� �� f� <br /> --------- Date- ------- <br /> -" <br /> 's. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t <br /> 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />