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FOR OFFICE USE. <br /> APPLICATION FOR 'SANITATION PERMIT Permit No. <br />- <br /> --------------------- --------------------------------- (Complete in Duplicated Date Issued <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 Aescribed. <br /> This application is made in compliance with County,Ordinance No.nceNo. 54 <br /> o se sols al l4l <br /> JOB ADDRESS A Lra, <br /> T10N. al__ ------ - E' -------••------------------••------------ <br /> r <br /> Owner's Name,V­ ----�1�--5----------------------------- ------------------------------ ----- ------------------------------ ------ Phone------------------------------------ <br /> Address - / ---------------------------------------------------------------------------------- <br /> Contractor's Name--- �------- --------------- Phone---------------------------------- <br /> Installation will serve: Residence tEiparfment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms 3--- Number of baths --1---- Lot size --- Z-- - - --------------_-..-_._ <br /> Water Supply: Public system H Community system ❑ Private ❑ Depth to Water Table -------- ft. f <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam,-El.—ClayAdobe ardpan <br /> P ❑ ❑ Y ❑ Y ❑ � ❑ <br /> Previous Application Made: (If yes,date--------------_._..1 No&"" New Construction: Yes E] No�HA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS <br /> (Na septic tank or cesspool permitted if public sewer is available within.200 feet.) ' <br /> t <br /> Se tic Tank: Distance from nearest well--------------._-Distance from foundation---------------_--.Material.----------._._.....______.__.___".----_-_-_-_. <br /> �( T/ No. of compartments--------------------------Size---------------i-:---------- ---Liquid depth-------- ... `- CapacitY •-------------------- <br /> Disposal Field: lJ Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line-__._-_---- <br /> )-p-V Number of. lines-----------------------------------Length of each line------------------------------Width of trench.------------- "------------------ i <br /> Type of filter material-------------------_----Depth of filter material----------------------- otal length------------------------------------------ <br /> Seepage P Distance to nearest well-------- _-----Distance om foundation--- _r_____.Distance to nearest lot li e9--._ �..._ <br /> Number of pits.__._________________Lining material_ � 5 ze: Diameter.3-3--del-_____Depth__- __h' ----- <br /> '07 <br /> Cesspool: Distance from nearest well------_----- --Distance from foundation____--- .__-__-.Lining material----._...._-"-----------------_--_--. <br /> ❑ Size: Diameter----------------------- ---------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. I <br /> Privy.: istance from nearest well_-,__.�.._�.__ _____��_ ._TDistance from nearest building----------------------------------- <br /> 1- . <br /> .�,. -et. <br /> ❑ a. . <br /> Distance to nearest lot line """"° ^�Win_ --- <br /> Remodeling a d or repairing (describe):----- ---------', ---------- `?• ------------ <br /> --------J------ <br /> -�✓ <br /> -•.��--------------------------------------------------- -------•----------•--------------------------•---------------------•----------------------------- ---------- <br /> --------- -------I-------------------------------------------------------------------•-------•---------------------------------------------------------------------------------------- --- --------------------------- <br /> Ij <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 I and rules a gala 'on f the San Joaquin Local Health District. <br /> �.__ Owner and/or ontractar <br /> (Signed)-. <br /> ---------- --------- ----- J--- , --------------------------------------------------------,1 ( 1 <br /> BY:------------------------ lav -[• --_ (Title Cf�� <br /> (Plot plan, showing six loft, location of system in relabotf to wells, buildings, etc., can be placed on reverse side). <br /> i FOR DEPARTMENT USE ONLY - <br /> APPLICATION ACCEPTED $Y ----- --------------------------------------- DATE----- - <br /> 1 y --------------------- { <br /> REVIEWEDBY---------------------------------------------- -------------------------------------------------------------------------------- DATE-- --- ----------------------------------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------- <br /> ------------ DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:_-___-_-- ...................___ <br /> ------------------------------ --------- - -------------------- <br /> I------ --------------- ------------------------------------------------------•--•------•----------------------------- ----------------- <br /> -------"---------------------------- ------------------------------------------- ---------------------------------- ------------------------- ----------------- ------- ------------------------------------------- <br /> --------- <br /> 1 <br /> Date---- <br /> SAN <br /> ---- <br /> FINAL INSPECTION BY:....�---------------`--_-- t � ! - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 16,�. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California a Lodi:California � ° NMan e,o,California Tracy, California,' <br /> s <br />