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4 -FOR OFFICE USE: <br /> - - -------- - ------------- APPLICATION FOR SANITATION`PERMIT Permit No. ke-` fo-- <br /> -= ----------- ---------- ------------------- ---------- <br /> ----------------------------------------- --------- (Complete-in Duplicate) ty' <br /> _ This Permit Expires 1 Year From Date Issued Date Issued ---------f= <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. r�Fr f�c� Ltd•... <br /> :..— A �f�--------- - ---- <br /> JOB ADDRESS ANDO.CATION ---- -- <br /> fiJA <br /> ~ <br /> Ph---------------------Owner's Name ------ <br /> 0-4 <br /> = 0- -------------- <br /> Address------------- ---- h <br /> w <br /> Contractor's Name- e z -- -- - ---------------------- ----------------- Phone--- ----------- - <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __�-._ Number of bedrooms _. - Number of baths y Lot size --- __ _.....-- ______------__________________ <br /> Water Supply: Public system ❑ Community system ❑ 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,date.. ..........._..- ) No ❑ New Construction: Yes ❑ No ❑ `FMA/VA: Yes ❑ No ❑ <br /> t TYPE OF INSTALLATION AND SPECIFICATIONS: '—- ­ P I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank:. Distance from nearest well___5'F� '-__Distance fro5fofoundation-----1a.........Material ---- ----- ----------------------------------- <br /> mm _ Sizq <br /> No. of copar#mes ' "r.` e' /�-/ S": Liquid depth Capacity r <br /> p "-'Distance from nearest well-.4-. ' "_Distance'from"foundation:-'/�-'------Distance'-to nearest"lot line ._.......... <br /> Dis os field:` Number of lines-----=----I---------------------Length of each line-- Q. Width of tranch.-- '_.------------------------ <br /> Type of filter material-------- --------Depth of filter material--_-_/ ._...___._-.Total length-_-_?_-------------------------- <br /> / <br /> age t: Distance to nearest well...-_.SO_--......Distance from foundation----/_4!----------Distance to nearest lot <br /> ` <br /> Ime..�._-------- <br /> ----- <br /> ..__.__ <br /> ___ t _ A --❑ Number of pits--- - �_.-..._.___Lining material___ -_.. c <br /> Cesspool: Distance from nearest well ----------------Distance from foundation._.-__- ------- ..Lining <br /> material-..-.__----_-_----_.------.__-_ <br /> ---.-. <br /> ❑ Size: Diameter- -- --------- - ----- - ------Depth------ -------- -------- --------- ----------- Li Liquid Capacity. - --------------___---_gals. <br /> -------�y- --^"� Distance from nearest building-Privy: � Distance from'nearest'well_-__--_------------------- <br /> ----------- <br /> E <br /> Distanceto nearest lot line----- ------ ------------------ --------•-----------------•---------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------- = -- ------ -------•-•-- -------------------- <br /> i <br /> -------- ---�----.it -------------- —3 ----- - <br /> • --f------------------------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done iri<accordance with San Joaquin County <br /> ordinances, State laws, d rules and regulations of the San Joaquin-Local Health Distrief.1 <br /> 4 F--i- u <br /> f (Signed)---------------------- ------ == --------" ---- -l, �"-(�" r Contractor) <br /> nd/o ntr or) <br /> ------ be <br /> (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can a plated on reverse side]. <br /> F ' <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- ----------- ------------------- ---- --- ---------- DATE--- - j ----------------------- <br /> 4 REVIEWED BY------- ----------------------- ---------------- - --- --------------------- ----------------- -------------------------- DATE------------- _- ------ ------------------------.__------- <br /> BUILDING PERMIT ISSUED---------- --------------------------- ----------------------_------- ------ DATE. <br /> _.. <br /> Alterationsand/or recommendations------------- ------------------------ .- ------------ --------------------------------- -------------------r----------- -- - - --- ----------------- <br /> i ------------------ -----------------=-------------------- ------ --------- ----------------------------------- ---------------------•------------------------ ----- <br /> FINAL INSPECTION BY:_x::;_ . ----- __- -------- <br /> SAN JOAQUIN,LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon 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 />