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FOR OFFICE USE: <br /> -�� <br /> ............. // <br /> 6--: AP�..(CATION FOR SANITATION PERK,.,, Permit No. <br /> ---------------------------------------------------- (Complete in Duplicate) -� <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 /> JOBADDRESS AND LOCATION....1_-t-�-f J(_-�--- --------------------------------------------------------_-------------_--- ------------------ <br /> Owner's Name.--U:I:54 <br /> -•----- - - - -------•-------------------------------------------------------------------------•------ ----------- Phone.-----------------------------••---- <br /> Address------------— -0--- -------------------------....----------------------------------------------------------------------------•-----------------------•-----------•--------------------.--- <br /> Contractor's Name--gid �_-.s....7--__�--------------------------•-----.--.--------------•-------•--•--------------------------._...-.----_. Phone........_-----------_-•----•------ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [q--vlotel ❑ Other ❑ <br /> Number of living units: _/!_ Number of bedrooms AZ__ Number of baths _��--- Lot size ----/G' .....--------------------------•-------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand [I Gravel E] S y Loam Clay Loam [:] Clay C] Adobe [I'Mardpan C1Previous Application Made: (If yes,date----------..........} No CE]New Construction: Yes ❑ No [—FHA/VA: Yes ❑ No El' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) <br /> t <br /> Sept- Tan j Distance from nearest well-----------------Distance from foundation--------------------Material-______._.-_-_-._-_---------______..----- <br /> No. of compartments-------------------------Size----------------------•- ---Liquid depth-- --------.Capacity--------- <br /> Disposal Fi Distance from nearest well.-. _-----Distance from foundation-- �---.--.--_Distance to nearest lot line- ------------ <br /> ❑l Number of lines------ ----------------------------Length of each line_ Width of trench.�.�__'�.__.________._...... <br /> �-C --•----- <br /> Type of filter materiaf__j?oG-/C.----------Depth of filter material./., -----------------Total length---.. ---------------------------- <br /> Seepage Pit: Distance to nearest well______________________Distance rom foundation.-/,-_r--.-.----Distance to nearest lot ------- <br /> Z__ Number of pits---.-.I--------------Lining material;_._/ 0(A_-.__.Size: Diameter------ff----------Depth__-...;�-)- ---------------- ' <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_..-----------------Lining material---._-.----_.-----._.___------_-___-_ <br /> ❑ Size: Diameter----- -----.Depth----------------------------------------------------Liquid Capacity. --------••-•------- ...gals. <br /> Privy: Distance from nearest well------------------------------------------------ from nearest building------------------------------------ __-- [' <br /> ❑ Distance to nearest lot line - - ------------------------------------------ -------•-------------.-.---------------------------------------------•---------------------- <br /> Remodeling and/or repairing (describe):__ - ----------------------- - -----------------------•-------------------------------------------- ------------••----.-----------•----------------- <br /> ------------------------------- ---------•---------------------------•--- --•------------------------------------------------•-•••-------------------•-------- -------•------------------ ------------ <br /> I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws rules r gulati ns of the San Joaquin Local Health District. <br /> (Signed) - ----- --------­­-- ......... •------------- -----(Owner and/or Contractor{ <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)-------------- --------------------- ---- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, 6uildings, etc., can 6e placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> 11-1710 APPLICATION ACCEPTED BY._....... _ <br /> DATE------- '.l�' =-------------------------- <br /> REVIEWEDBY-- - ----------------------- ------------------------•---------------------- ---- ------------------------------------- DATE----------------------------------------------------------=- <br /> BUILDINGPERMIT ISSUED------_----- -----------------------------------------------------------------------.-------------- DA-TE------------------------------------ ------------------------ <br /> Alterations and/or recom endations:--------- ---------- _- - <br /> ___________..___.. ---------.....-.- <br /> -•--• - - -- <br /> ------- <br /> G � <br /> ------------------- ------------ ------------ --------------------- --------------------------..._----------- -- ---------------- --------•---•---------------------- ----------------------------------------- <br /> FINAL INSPECTION BY:........... . -------. _-- <br /> Date_....._ __.f — ------------- - --- --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> F.F.0 13. <br />