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FOR OFFICE USE: �p <br /> =r�------------- ----- ----=3--... <br /> ----------- ------------ -- ---------- ----------- - <br /> APPLICATION FOR SANITATION PERMIT Permit No. .,:2 3 <br /> ­-- - ---------------------------- --- (Complefe•in Duplicate) <br /> :--..-.. This Permit Expires 1 Year From Date Issued Date Issued �- <br /> k <br /> Application is hereby rriade to the San Joaquin Local Health District for a permit to construct and install the work herein described. r <br /> I""""" This'applicatian is-made incompliance with County Ordinan e No. 549. <br /> JOB ADDRESS AND L CATION---- ---__ <br /> �C- --- -------- -------- - <br /> -------- 1 - ----- <br /> Owner's Name- - ---- ------ = --- --- --------- - ------ Phone--4&-4-3-0-¢-Z <br /> Address......._ ; <br /> --------------------------- ------- ------------- ---------------------------- -------------------------------------- ------------------------------ <br /> Contractor's Ndme Phon -- .(!� -. � ... <br /> `. , <br /> k Installation will serve: Residence Apartment House ❑ Commercial-F] Trailer Court ❑ Motel ❑ Other ❑ <br /> I� Number of living units: -- -___ Number of bedrooms -2-_ Numbe of baths-.I---- Lot size -- 5---. ---.Z d40----._------------- <br /> Water Supply: Public'system Community system ❑ Private ❑ Depth to Water Table 7S- ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeOfHardpan ❑ <br /> Previous Application Made: (if yes,date-------------- ) No ] New Construction: Yes ❑ No 4, FHA/VA: Yes ❑ NoI L _1K <br /> ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> Septic Tank: Distance from nearest weil----------.------Distance from foundation--------------------Material -------.___._._.-..--__.._.-----.._--_._..--_-. <br /> ❑6)Ct,S7. No. of compartments-___.. ------- ----Size--------------1i----- -----------Liquid depth---- - -- - - - - --- - Capacity----------------------- <br /> Disposal Field: Distance from nearest well_0-Pe.Distance from foundatio--- —---_._.Distance to nearest lot line--4'p-- <br /> mb 9 . <br /> Number of lines_C tJZ-- l-. .-..--Length of each line-. 9QLr--� -.----Width of trench.- (t <br /> Type of filter material---- - - ---- ------Depth of filter material.....ff.",_. ._____-Total length--------�a---------.---------------- <br /> 1 Seepage Pit: Distance to nearest well---------------------- from foundation----.--_---.------ Distance to nearest lot line----------------- <br /> F-1 Number of pits -- ----- _-- --Lining material--------{------------ Size: Diameter-------------------.---Depth--------------------------------- <br /> I <br /> Cesspool: Distance from nearest well ----------------Distance from foundation---- .-----.----- ..Lining material-...---------------.-----------------. <br /> Size: Diameter- -- ----------- -De th-'---------t..-----------_.----------------------------------------Liquid Capacity -----------gals. <br /> Privy: Distance from nearest well --------.------ - ` -Dista�ce from nearest building-------------------------------- - <br /> - ------------------- <br /> ❑ Distance to nearest lot line ....{----------------------- -------------------------------- <br /> Remodeling <br /> - - - <br />� <br /> Remodeling and/or repairing (describe):-- -- L -- - ---------- -- ----------------- c <br /> i -----------•---------------------------------------•----- ---------------- _-------------------------,:------------------------------' - ------- --------------------------------- <br /> -------------- - ----'----- -------------------------`---.--------- ----------•------------------------------------•----------------------------------. <br />* f hereby certify that epared this application and that the work will.be done in accordance with San Joaquin County <br /> ordinances, Stat s, nd rules a ( r:gulat ns of the San Joaquin cal eat+h District. <br /> - ---- ----- r- ~ <br /> 4 (Signed)------------------------- --------- -------- ---- o n- (Owner and/or Contractor) <br /> �t.�-a. ------- Title <br /> BY:----------------------- ------ - ------- --------- { ) <br /> (Plot plan, showing size o ot, location of system in relation t wells, buildings, etc., can he pla on reverse side). <br /> a <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - i <br /> ------------------ -------------------- ------ - ----- DATE-f"/77-6-7 --- ---------------------- ------ <br /> REVIEWEDBY------------------------------- ------- '-- ---€----------------------------=--- -------------------- DATE------ ------------•---------------------------------------- <br /> BUILDING PERMIT ISSUED-------- --------------------------------- € ---------------==---------- .................. DATE.--------- ----------' <br /> Alterations and/or.recommendationi: ----.-------- -- --- -==------------------------------------ ------------------------------------------------ ----------------- <br /> .. <br /> ---------- -- - ----------------------------------------- ---------------• - - -----------------------------------•----------- ----------------------•.-----..--------------- ----- ---------- ------•------------------- <br /> 'i <br /> ---------- -------------- -- ----- -----------------•-------------------------------------- ---------- * ... <br /> -------••---•------•-------------------- --- - ------• -------------------------- --------------------------------- ----- - --------------------------------------------- -- ---- - ---- --- -- <br /> i pp <br /> FINAL INSPECTION BY:. . ... .---------- ------------- a Date.... -Q_-_- �� 7----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I 1401 E.Hasellon Ave. 300 West Oak Street 724 Sycamore Street 20.5 West 9Th Street <br /> Stockton,California r Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 7-67 Vanguard Press <br />