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FOR OFFICE USE: <br /> _________________________________________________________ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------ <br /> --------- ------------------------ -- ------ <br /> (Complefe•in Duplicate) 6 <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 A/N►Dy LOCATION- -- l �-----=- +__. / <br /> --. <br /> Owner's Name-- -- ------ -- r = ` <br /> ----------------- <br /> ----------------------------- E--- ------ <br /> �Q� <br /> Q <br /> f � <br /> ---------------------------- <br /> Address-1:0,514//pp0_ <br /> Contractor's Name------ L�.fN-r��----------------- ------_--------------------------- ------- ----------------------- --•----------------• Phone:��_------_ <br /> Installation will serve: -Residence ®/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -. ----- Number of bedrooms a- Number of baths./-_-- 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,dote_- ..-------....... ) No K],-' New Construction: Yes ❑ 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 /> Septic Tank: Distance from nearest well-----------------Distance from foundation__------------------Material ----------------- --------------------...._... <br /> F1 No. of compartments------------------- --Size-------------------- -----------Liquid dei lri -------- ------- --- --- Capacity----------------------- <br /> 0--0------.Distance to nearest lot lin` _ [ <br /> Disposal Field: Distance from nearest well—T757 Distance from foundation „r <br /> Number of fines --------�----- --------------_Length of each line__/Q.G1_`��___-__Width of trench-gam�-_--_-__-___----_._ <br /> Type of filter materiaQ -C.4ktk-Depth of filter material_f_?.............Total length p---------------.-------..___- \P1 <br /> Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distant to nearest lot line-..----.----...._ <br /> ❑ Number of pits.-- ------------------Lining material---------------------- Size: Diameter_----------- 'Depth--------------------------------- <br /> Cesspool: Distance from nearest well ------- Distance frdm foundai-ion __ _____________ __Lining'mato 'aL_.___._----__.---------------------- Q <br /> El Size: Diameter- -- --------- ----- ------------ ---Depth-------------------------------------------------..Liquid Caper------------- - gals. <br /> Privy: Distance from nearest well--------------------------------------- -------.-Distance from nearest building..-._--_-_------..-------..._....____-- <br /> ❑ Distance to nearest lot line ....022 <br /> , -------------------------------------- -------- --- ----------- - - -- --------------- <br /> Remodelingand ''in describe .. k '� `ter- ,/'1� -. � . .-E___ <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, Stat laws, nd rules and regulations of the San Joaquin Local Health District. <br /> (Signed)- �L -� --- - �1:1r�. -- -- -------------------------------•---------' (Owner and/or Geer) <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----.----7_.-A-. •-------- --------- - ----- ------------------------- -------------- DATE-- -----'3-- z"? �.�t --------------- <br /> REVIEWEDBY------'------------------------------------------------------------------ --- - -------------- ----------------------- ------ DATE-------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- -- ----------------------------------------- --------- ----------------- ---------- ----- DATE---------- ------ ------------------- <br /> Alterations and/or recommendations------ - - -- -- -------- ------------------ ------------ ----------------------------• <br /> -------------------------•-------------------- ---------------------------------­­------- ------------------- -------- ------------------------------------- ------------------------------------------------ <br /> FINAL INSPECTI - -- - Date ---- -------------- . --. = ------1------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon 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 />