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----------- -------------- <br /> •- - � APPLICATIONON FOR SANITATION PERMIT Permit No. <br /> ` (Complefe in Duplicate) <br /> - -- This Permit Expires 1 Year From Date Issued Date Issued -1.4-._-� <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]----------- __Y_�-------_�-�-------- ------------------------------------------------- ---------------------------- <br /> Owner's Name------- h6..e> l r <br /> -•--•---------------------------------------------- •----- ....... Phone--.�/- .` <br /> Address-----_--------------5`-!Y- !/1/ f/ftp------------------------------ <br /> Contractor's <br /> -----------------. -_ <br /> Contractor's Name------------ R-__�s--•-------•---` -L• ----------•----------------- ----------------------------------------------------- si / � <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot Other ❑ <br /> Number of living units: _I_.___ Number of bedrooms _/ __ Number of baths __/__- Lot size __._4 Q_�_A_ __ ______________ <br /> --------- ---- <br /> Water Supply: Public system B- Community system ❑ Private ❑ Depth to Water Table,��_-f ft. <br />' Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam 0 Clay Loam, Clay [] Adobe ET Hardpan ❑ <br /> Previous Application Made: (If yes,date__..___- ) NoConstruction: ` i <br /> � --- [�" New Yes ❑ No [5— FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) <br /> I <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------- Material-----_______-___...______.-_____-_-.______ --- <br /> No, of compartments--------------------------Size------•------------------------Liquid depth--------------- ---------Capacity----------------------• ' <br /> Disposal Field: Distance from nearest well.---4`----..Distance from foundation____],6----------- <br /> to nearest lot line_-f___�________ <br /> Number of lines- ­-----_-1---------------------Length of each line------- fid '--•----------Width of trench----?te 7 -t <br /> Type of filter material_____ ...-.-Depth of filter material___._!_�X_".-______Total length--------Y-d___`_______________ <br /> Seepage Pit: Distance fio nearest well <br /> ------_----------Distance from foundation---!_4-------•.___Distance to nearest lot line_:r_.._-.______ <br /> [�^ Number of pits__)----_L_ ______.-Lining material-----_lt'.�4_-<__--- <br /> Size: Diameter J-.------Depth <br /> ------- <br /> Cesspool: Distance from nearest well----_-----_------Distance from foundation---_----------------Lining material__-.__-_._____._____.________________ <br /> ❑ 5ize: Diameter-- I ----- ------- -------- ---------Depth------ -------------- ------ ---------Liquid Capacity---- ---------------------gals. <br /> ❑ Distance to n t <br /> Privy: Distance rom <br /> I--------------------------- -_-----------.-Distance from nearest building---------------------------------- <br /> earest lot line------------------------ -- -•----------------- <br /> Remodeling and/or repairing (describe)_____________________ <br /> ----- - - <br /> ---- } ------------------- -----; ' <br /> --- -• --- <br /> -i-t t :... <br /> ' -� ��--- - ------ <br /> --------- --------------------------------------------------------------------------•---------•--------- -- _ -------------- <br /> I - ----- -. --- <br /> hereby certify that I have prepared this applica}ion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Lodal Health District. <br /> (Signed) -a- ,. _, t <br /> ---(Owner and/or Contractor) <br /> Y ------------------------ ---------------------�-------: - Tttle ` <br /> Y <br /> (Plot plan, showing size of lot, ocatioi of system in relation +o wells, build' ( ] <br /> P 9 1 lings, etc., can be placed on reverse side): <br /> r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_________.�___ <br /> REVIEWED BY ------------------ ------------------------- DATE---- f <br /> BUILDING PERMIT ISSUED------• .---- = --------------------------------------- I <br /> --------------- <br /> Alte ations �d/ r�rgcommendations: -------------- <br /> an DAT <br /> .l� ----------- <br /> 3 �.--- � ------------ <br /> r r�� - :.M- = . <br /> IF�------------ ------------------- -------------------L-------------------------------- <br /> ------------------------ ---- ------ ------- ._.--------------------- <br /> ________________________________________________________________ F <br /> ----------------- <br /> -------------------------I-------------------------------------------- ------- ------ ---------------- <br /> ---------------- -------------------------------------- 1 <br /> i <br /> --------------------------------------------- ---------------------------I----------------- <br /> FINAL INSPECTION BY------------ --(?&"-------- ---------------------------- Date__, �._.- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r i <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycarnare Street <br /> s' 1 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 1 <br />