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FOR OFFICE USE: <br /> ----- �-- -- --------- -----------1i----�' �. �.. <br /> -r--/-�...-_*._�__.._ .__..-__�u,_,�_�.. APPLICATION FOR SANITATION PERMIT Permit No. _lze�XX.. <br /> -------- ------------------------- --------- (Complete-in Duplicate) <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 LOCATION-_,3., ---- - <br /> Owner's Name.__.`�'__�_!le-__ {l_s �^ __-- f <br /> ----- s'--------.-. Phone------------------------------------ <br /> Address . _. O `' ---------_------ ----------------r---- f-----------•------/---•- <br /> Contractor's Name_.___ <br /> S <br /> Installation will serve: Residence Apartment House Commercial ❑ Trail r Court E] Motel [3 Other <br /> �+ y� <br /> Number of living units: _- "--- Number of bedrooms_._ Number of baths '------ Lot size� . �_____-__-.-- <br /> Water Supply: Public system Community system ❑ Private �pth to-Water TablZ®_ <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- } No ❑ New Construction: Y s 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 /> "-Distance <br /> Septic Tank: Distance from nearest we/,PP.--__Distaanc�er fro{)fou da4ion__/.0-.-___..Material _-- ___________________ ___ ________ <br /> No. of compartments_ __________________Sizeic _7=�:T -__Liquid depth___ pf(__ __--.---Capacit�. i <br /> Dispos I Field: Distance from near wVP„--Distance from foundation__.1�� .Distance to nearest lot line ... <br /> W. Number of lines _._ ____ _______ _ ----- <br /> Length of each IinefCa`_-f'- --, -_-Width of trench-��#- <br /> Type of filter materi - -_.-_- - _ Depth of filter material__. .-_r-----------Total length------ ______�-_ <br /> t � � <br /> Seepage Pit: Distance to nearest ell) ......._--_Distance from foundation__ Distance to nearest lot line__.___-._ <br /> Number of pits__- . ----.___.__Lining material___ - ___ Size: Diameter._.-Z.3___-----Depth.....Q _1------------- <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 /> ❑ Distance to nearest lot line-- --- ---------------------------------------------------------------------------- ---------------- <br /> Remodelingand/or repairing (describe):...-----_ -------------------- ---- - ----------------------------------•------------- ------------- ------------------------------------------------ <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 q <br /> ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. { <br /> DAY&NIGHT <br /> [Signed)-,_- ------------�_e 1c_YcsnkSermica---- ------ ---- ------- ----------•---- ------------------ r Contractor) <br /> HO <br /> By% �taektu1�; �dil� - - --------------(Title)---------- ----- -----..-------------.------------------- <br /> (Plot plan, showing size of lot, location at system to relation o wells, building etc., can be placed on reverse side. <br /> RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._-._------: � __-_----2� DATE--___-{ -.� ; <br /> --------------------------- <br /> REVIEWED BY------------------------------------- --- - .. -- DATE-------- <br /> BUILDING PERMIT ISSUED---------- ------ -------- . -- ------------------------------ DATE------------------------------- --- ------ <br /> Alterations and or recommendationsy --------------------- y -------•---------- --- ------- <br /> R 'r <br /> ----------- <br /> ...P- <br /> le.lofr------- <br /> ----------------- ------ -------------- -- OSANJ' <br /> - ----------- ----------------------------------------------------- ----------- - --------- -......---- • --...---_.-: <br /> -------- --- <br /> ­. . .. <br /> ...... ......................................... <br /> -I--------------- <br /> FINAL INSPECTION BY:--------- ---.-- Date.-.-.-. °----- -O UIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />