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rUK(JI-t- -L Ube: <br /> ---------- --------------- ---------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------I-------- --------- (Complete in Duplicate) <br /> 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 described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..___ --_ --- 7---------_ ----..-----71 - <br /> - _� <br /> Owner's Name- --���'+ch3-------��-_--'af---x-----_��_ �-------------�---�----------'- ------------------ Phone_ ----7-•�-g_�- <br /> Address fQ �^" !`1W <br /> 41 <br /> Contractor's Name--- -- `�j-------- -- - ------- - -------------e�---av-�_ o ------ Phone.... <br /> Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other <br /> ��L__ ❑ <br /> Number of living units: __ --- Number of bedrooms _3___ Number of baths : _ Lot size __ _11a ------- <br /> Wafer Supply: Public system © Community system 0 Private ❑ 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,dote....................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: .� <br /> r <br /> —(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--A ��__Distance;fro m�foundation___ _' _-__-_-Material---- <br /> ._._____...______________________________. <br /> No. of compartments.--------�.- _-----Size-- ..+� ---; -Jf�IA_Liquid depth...._-_1�-----------------Capacity---119d0------- <br /> Disposal Field: Distance from nearest weii_1Q0.Q_Distance from foundation._/A---___._.Distance to nearest lot line__// <br /> -- --------- <br /> [ Number of lines__________�_______.___.._____Length of each line------- S0-`--___-,Width of trench-------42- `-------------- <br /> a <br /> Type of filter material.__ . epth of filter material_4i4;Z/- _._Total length-----AVe-------------------------- <br /> Seepage Pit: Distance to nearest well-------_--------------Distance from foundation--------------------Distance to nearest lot line___________._.__ <br /> ❑ 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----------------------------gaIs. <br /> Privy: Distance from nearest well------------------__---------------_-------------Distance from nearest building------.._____-------_-_____-f <br /> ❑ Distance to nearest lot line-------------------------- ------ - --------------------------------------------------------------------------------------------- ---- <br /> Remodelingand/or repairing (describe):--------- -------------------------------------------------------------------------------------•-------------------------------------------------------- <br /> ---------------------------I—----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------- ----------------------------------------------- <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)----------------------------•------------------------------ ------------------- ------------------------- ---- -- --------- --------(Own and/or Contractor) <br /> -a `By:-- ---- -----r{--- - --- -(Title)--- ------ - <br /> r <br /> (Plot plan, showing size of fot,-location of sys+ern in 1elation to wells, ildings, .etc.,.rcan,be place onrreverse side). "Ppa.� �fo <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTrD. <br /> --- --- - -------- ----------- --------------------------------------------------------- DATE-- <br /> BY----- ---------- -------- -------- -------------------------------------- -------------------------------------- DATE------------ ----------•------------------ ----------------- <br /> BUILDINGPERMIT ISSU ------- ----------------------- --------------------------------------------------- ------. - DATE.- ------------------------------- ------------------------ <br /> .'Alterations and/or recommendations--- ------------------ ------------------------------------------------------------------------------------------------•--------------------------------------- <br /> -----------------•-------------•-- --------------------------------------------------------------------------------------/-------------------------•------------------------ <br /> --------------------------------------------- --------•---------- ---- - --------- ---------------------------- <br /> -------------------­­------- --------------- ---- -- ----------------------- ------------•- ---------------------------------- <br /> y� <br /> FINAL INSPECTION B :------- ---------------------------------------------------------G - Date------- <br /> AQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haz llon`Aye, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca, California Tracy,California <br />