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FOR OFFICEUSE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ......:............... <br /> ---------------------- ---------- --------- - - ------- (Complete in Duplicate) <br /> ' Date Issued /7 <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 compliance with County Ordinance No. 549. / <br /> JOB ADDRESS AND LOCATI N----/_1__J____/--- ®- -- ------- "' ---- -------- ; <br /> Owner's Name_/f: -7-_7------ <br /> ------- ----- --------- - - ------------------- - --------- Phone-//A--3'p__Z: <br /> Address------ <br /> ��/----- '... <br /> Contractor's Name---- ►"i:.f --•------- •-- Phone <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other ( ! <br /> Number of living units: ___)_-__ Number of bedrooms _"''—Number of baths j--- Lot size _ _ `Z-----cezi t--------------------------- <br /> Water Supply:" public system El Community system E] Private V Depth to Water Table �_ ft. <br /> Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_------------------} NoP5.., New Construction: Yes No ❑ FHA/VA: Yes ❑ No,14, <br /> s <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 280 feet.) <br /> Septic Tank: Distance from nearest well-__/)V Distance from foundation__-l--d__.__....M feria!___ b_ C.e__________- <br /> No. of compartments-----n---------1 ts...Y_to.X�y---Liquid depih--------- ----------Capacity--/0-C9P----- <br /> _ .__Size_ - - fit <br /> Disp sal Field: Distance from nearest well.41-6-----Distance from foundation�__ -------------Distance to nearest lot line____.__._____ <br /> ` Number of lines--------- -- ----------------Length of each line_-__41 r, Width of trench.___'- ----.-- <br /> f Type of filter material/....----Depth of filter material___ . _ _-----.Total length___--- - _-Q-------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El-„ Number of pits---------------------Lining material-----------------_-----Size: Diameter----------------------- Depth---.----------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___________________ Lining material---.--..----____-_-.____------------_. <br /> ❑ Size: Diameter---------------------------- --------Depth_-------------------------------- ---------- ----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well________________._._-----------------------------Distance from nearest building---------------------------------------------------------------- --- <br /> i _ <br /> E ❑ Distance to nearest lot line------ -------- <br /> ------------------------------------------------------ ------ <br /> Remodeling and/or repairing (descriI2�e):------- -----_--------------- -- -----------------• -----------------------------------------•-------------------•------------------------------------ <br /> -------------------------------------------------------------------------------------------- ------ -------------•------------------------ -- -- <br /> I -------------------------------------- <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 /> - (Owner an <br /> (Sign ed)-- • - - ----------------- <br /> By <br /> --------------- <br /> By---------------------••----------------------•------- <br /> (Title) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., canbe placed on reverse side). <br /> j FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -- --- ---'----------- ------- -- �G -------------------- DATE------ ------------ l- -------- ---------------- <br /> 3 <br /> -- ------------- -- <br /> REVIEWEDBY--------------------------------- -------- --------------------- DATE_----------------- ----------- <br /> T <br /> --------- <br /> BUILDING PERMIT ISSUED-------------------------- ------- ------------- ------------------- DATE 33 <br /> Alterations and/or recommendations:._.._---- _ e ---�- - -------- f ---- <br /> ---------- ----------------------- --------------------------------------------------------------------- ------------------•---------------------------------------- <br /> --------------------------------------------- ------------------ <br /> Date. <br /> z/-6 <br /> ( `_ --------- - --------•- ------ ------------------------------------ <br /> FINAL INSPECTION SY:. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Iia:Elton Ave. 300 West Oak Street 'k 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California `7 Manteca,California Tracy,California <br /> F.P.CO. <br />