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r FOR OFFICE USE: <br /> alta...................._____..__ _�---- APPLICATION FOR SANITATION PERMIT Permit No. ...... ../....../...-__. <br /> J �--------------------------- (Complete in Duplicate) <br /> Date Issued <br /> --------------•.............. -..-- This Permit Expires 1 Year From Date Issued .._._ _....... <br /> Application is hereby mode 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 AND LO ­-------------------- •---•..............--------=------•=-•----...........-. <br /> I t <br /> IOwner's Name II ----------------------------.......................................................... ..'..:_. Phone.................................... <br /> Address.....-��� � I ------ ................... ... .: : <br /> I ,fi ---------- <br /> Contractors Name........ - -- - ........ <br /> --•.��.Q-----:.�_.._..._--...;-:----•--°---•---'-'_--------- ------------------------------------- Phone----------------------------------- <br /> Installation will serve: �1Residence ertment House Commercial . �-,Trailer Court Motel <br /> /��P - ❑� •� ❑ ❑ Other ❑ <br /> Number of living units: -k- Number.)of bedrooms.;z--- Number of baths /_._ Lot size%� >D-......_....... <br /> 1 ; j rJ . �` <br /> Water Supply: Public system ❑ Community-system E] Private �epth to Water Table _lpnf. / <br /> Character of soil to a depth of 3feef: Sand ❑ Gravel ❑ Sandyxoam ❑ Clay Loam ❑ Clay ❑ Adobe 8--_H�rdpan ❑ <br /> Previous Application Made. -(If-yes-date-� _...... .. ..) NoJ?"New Construction: Yes 0,-No ❑ FHA/VA: Yes PP No ❑ <br /> TYPE OF INSTALLATION`AND SPECIFICATIONS: <br /> (No septic tank or cesspool permi#ecJ if public sewer is available within 200 feet.) <br /> Septic Tank: Distance frorn nearest-4. __ oW.....Distance from_f�jnda iion.-.l'0�'.---Materia't...!%_�!. <br /> L <br /> ------------ <br /> No. of com artments. � ._......_. .Size `,� f <br /> p .1 _._-a� �{Q.Liquld depth. !�? Cd pa <br /> r:.. p � i w.� <br /> Disposal Field: Distance(from nearest well... p_--_-Distance from foundation-_,r<�_.......Distance to nearest lot line-aS -.--_ <br /> Number of lines.___.---- rLengtn of each Width of trench A--......................... <br /> Type of.filter maferi'al.,�.Depth of filter material..OAW�--_Total,length- `�� .� .. <br /> J <br /> Seepag Pit: Distance�to nearesf well..-`4�.�...;Distance fro-Jfo�dation--- � Distance to nearest lot lin©.3.�.� S <br /> Number of pits....,;9. material_��1G-_:Size: Diamete .........._Depfh_,ZO.�.......:....___... aQ <br /> I <br /> Cesspool: Distance from nearest well-------------:.r Distance from foundation--------------------Lining material................---------------------- M <br /> Size: Diameter:- '- --- 1......... .Depth---•-.-.--•------------------------- ---- ------Liquid Capacity-------•--------------------gals, <br /> Privy:. Distancelfrom.,In'eorest well_...-._________________?._._-__-.--._...........Distance from nearest building._..................__. <br /> ❑ Distanceto nearest lof'line---- -------•------I-------.. <br /> .--................ ... ..... <br /> Remodelingand/or reieirin ibe : , 4 <br /> ...... <br /> --- <br /> --------=- r --------------------------------------- <br /> ..._......••.._.__._.. ------ ------ ------------------..--...._-• - - <br /> I hereby certify that I heve,prepared this application 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 Local Health District. r <br /> (Signed)------------------ "- •-- --- -- ----- 1 '� - - -- ----- - <br /> :-------------- -------------- - -------- � Contractor) <br /> B . �-- rt <br /> (Plot plan, showing size✓of'lot, location of system in.rel n to Wells,,buildings. etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... ......... ..�_...-. �..._..._____--...... .....----------------------------------- 63 <br /> DATE.._.-./a-• -----'- - <br /> REVIEWEDBY .................................. ..........-•-------..................._ -------------------- DATE--- <br /> BUILDING PERMIT ISSUED-------------- '- ------------------------------------------- - --------------------------------- DATE-..-----_---••------ ........,------------------------ - <br /> Alterations and/or recommendations:.-- -------- --• <br /> - <br /> -------------- <br /> ----- - -- --------------- �s '. <br /> ..-�� --� - - --- ......----------•------•--------------. ..--- ---- <br /> 2 �G G3 -- <br /> FINAL INSPECTION BY:-------- ..- rG- ------------------------------ Date--------- .. . ....................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,Colifomlo Tracy,California <br /> C5 9 PrVISED 0-59 3M 3--63 F.F.CO. M1 <br />