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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. .r �� <br />--------------------------------------I------- ------ -- (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 workherein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND T CATION - ----- <br /> Owner's Name----- ---------------- Phone--------------- ------------ <br /> ------------------------------------ <br /> Address--------------- .-----) - <br /> ' •------- ''"�1 ---------_------------ <br /> - r e 7+ <br /> Contractor's Name------- ----- A/-------------------------------------------- Phone---------_---------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1.---- Number of bedrooms -"._ Number of baths �-_ Lot size _____ __ -------------_-_____-_____.-_ <br /> Water Supply: Public system ❑ Community system ❑ Private k Depth to Water Table tag ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam] Clay ❑ Adobe❑ Hardpan. <br /> Previous Application Mader (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No-se fic tank or cess oolermitted-ifu6lic sewer is"available-within'200 feet- <br /> Septic lank: Distance from nearest well-15,471 Disfancq_frQm foundation______ _ ------Material_ ._-_-._-_---..--_--_._-___-y__ <br /> '- dit <br /> No. of compartments-.-.X-------------------Size -_TNr.�_"__ ._ ,! ___Liquid epth__- --------.___._.___Capacity_, -_�_______ <br /> r i <br /> Disposal Field: Distance from nearest well____----Distance from foundation__•�_V�.............Distance to nearest lot line---r-_-.----- W <br /> Number of lines-----/---------------------------Length of each line----.1_ _`--------------Width of trench,;.,.-_Y--"--------------------- I, <br /> Type of filter materiajo&_�'---------Depth of filter .material__,___*-______Total length-_ --------------------------- <br /> Seepage Pit: Distance to nearest well-.147P---- Distance from undation_-14---------- Distance to nearest lot link* .--__-_._ <br /> J Number of pits--- '-------------Lining material .- --...--- --------Size: Diameter__.3. ` ---Depth_ .�- -------------------- �_,l <br /> Cesspool: D•stance 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 /> Remodeling and/or repairing (describe):--------- -------- --------------- ------------------------------------------------------------ -------------------------------------------------------- <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 re ulations of the San Joaquin Local Health District. <br /> �i <br /> (Signed[- `'�'�' � � -----------------------------------------------------------------------------------(Owner and/or Contractor) <br /> = — ------------- ----- ------------------ <br /> (Plot <br /> _ <br /> (Title) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- __ r' DATE---- _:r�r`�" .C__-------- <br /> ___ <br /> .- - <br /> REVIEWEDBY----------------------------------------------------- ------------------------------------------------------------------- DATE------------------------------ <br /> BUILDING PERMIT ISSUED-----•------- --------------------------------------------------------------------------------------- DATE---------------------------------------------------------. . <br /> Alterations and/or recommendations---------------- -----------------------------------------•------------------------------------------•-•-------------------------------------------------------- <br /> -------------------------------­ --- - ------------------------------------ ---------- ------------------------------------------------------------I---------------•------------------------ ----------------------------- <br /> -------------------------------------------------------------------------------------I--- ------------------------------------------------------------------------------------------------------------------- <br /> ----------------- -------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- <br /> --------------------------- ------------ ------ --- <br /> FINAL INSPECTION BY:140._ .. .. ..,, -------------- Date .. -------- - - - ------ ------ --------------- <br /> SAN JOAQUIN L9C,4L_RE_ A TH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Streetsycamore Street 205 West.3tli Street <br /> Stockton,-Califorlia- Lodi, California ,California Tracy,California <br /> F.P.CO. - � <br />