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FOR OFFICE USE- <br />----------- ----------------- ---- APPLI CATION FOR SANITATION PERMIT Permit No. <br />- ---------------------------------------------------- <br /> -------------------------------------------------- (Complete in Duplicate) Date Issued --- <br /> *­------------------------------I------------- L This Permit Expires I Year From Date Issued �! <br /> Application is hereby made io`fhe San Joaquin Local Health District for a permit to construct and install the work hereind c ibed <br /> This application is made in compliance with County Ordinance No. 549. <br /> IAI 14r, <br /> ----------------------- <br /> -- ----------- <br /> JOB ADDRESS AND LOC"10 N ------4 - ... ----------------- <br /> Owner's Name- ------- ........ -0 - ---------------Z) ------ ------ <br /> Z ------- Phone_ <br /> ......... <br /> Address----_------------23(--------- -- ---- ---------/0--Z------------------------------------------------------------------------------------ <br /> Contractor's Name------------ ---------------------- ---- -/90,/k7f 4_7 <br /> Phone- <br /> Installation will serve: Residence [I Apartment House E] Commercial 3-1railer Court E] Mofel [] Other E] <br /> Number of living units: __0__ Number of bedrooms ___-19 Number of baths ---f--- Lot size -------- �. ------------- <br /> Water Supply: Public system Ej Community system El Private [Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam [Clay Loam [] Clay ❑ Adobe [] Hardpan 0 <br /> Previous Application Made: (If yes,date--------------------) No &"' New Construction: Yes [4Ao 0 FHA/VA-. Yes [_1 No [� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if P,.*Iic sewer is available within 200 feet.) <br /> 0 0fr0-,v <br /> ------------ <br /> Septic Tank: Distance from nearest well_2_5 _."--lDistance from foundation--/4P------- -Material--- 0."_.5--------- <br /> -------- --- <br /> 191- No. of compartments-------- - ---------------Size_.��XA_f�'O--------Liquid cleIofh-"_ ------------Capacity_O-: <br /> Disposal Field: Distance from nearest we <br /> "6;.11._S�2.....ODistance from foundation. <br /> e ......Distance to nearest lot line_1,------- <br /> Number of lines____-_ _______ Length of each line--,e ---__..___-.._- <br /> Type <br /> ------------------Width of french <br /> Type of filter material-- Depth of filter maferial_]�. --- --------Total length------1-6-0----�t---------- SJ <br /> Seepage Pit: Distance to nearest well .------------------Distance from foundation------ -------------Distance to nearest lot line__.-_._____._---. a a <br /> ❑ <br /> ine----------------- <br /> El Number of pits----------------------Lining material----------------------,Size: Diameter----------------------Dept h-...-. --- ---------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 't <br /> ❑ <br /> aterial-------------------------------------- <br /> ElSize: Diameter--------------------------------- ----Depth------------------ ------------------------- -------Liquid Capacity- . ------------------------gals. <br /> Privy: Distance from nearest well- - --------------------------------------------Distance from nearest building------ ----------------------------------- ?19 <br /> ElDistance to nearest lot line-------- ----------- -------------- ----------------------------------------------------------------------------------------------------- - <br /> Remodeling and/or repairing (describe):-------- ;Ikov _S: --- -- --- - ---- --------- -,e-------------------------------------------- <br /> ----------------------------------------------- <br /> ------------------------------------------------ <br /> --------------- -------------A` -------------------- -------------------------------------------------------- ------ <br /> ---------------------------------------------------------------------------- <br /> -------------------------------------------------I------------ <br /> ------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- ------ <br /> 1 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 irud regulations of the San Joaquin Local Health District. <br /> (Signed)---------------------- --- ---- -- -- --- ------------- --------------------------------- _- n nd/or Contractor) <br /> f ----------------- <br /> -------------------------------------ITitle)_ ------ <br /> By:---------------------- -- -- ------ ------------------ ------- --- --- <br /> s S" <br /> (Plot plan, showing size YPot,=iloat�io, ofi�W4+em in relation to wells, buildings, etc., can be p arced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY---- -- ---- ------ ------- ---------------------------------------- --------------------------- <br /> REVIEWEDBY------------------------------------ ----------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------- -------------- --------------- <br /> Alterationsand/or recommendations:------------------------------------- -- ........-------------------------------------------------------------------------------------------- ---------------- <br /> ------------------ --- ------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------- <br /> ------------------------------------------------------ - ---------------------- -- --- -------------------------------------- ------------------------------------------ --------- ---------------- <br /> ------------------------------ -----------------------------------I ---------------------------------- ----------------------- ---------------------------------- ------------------- ------------------ ------------- <br /> ---------------- ----------------------­.­- -----------------------------­­-------------------------- --------------------------------------------- -------------------- ------- ------------------------------------ <br /> FINAL INSPECTION BY:__A4_11�1' ------- -------------------------- Date. - ----------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />