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r FOR OFFICE USE: <br /> ---------------------- ------------- <br /> ------------- APPLICATION FOR SANITATION PERMIT Permit No. -. ��._.IP 0 <br /> ------------------ -------------------------------------- (Complete in Duplicate) 1�l <br /> Date Issued ______ <br /> This Permit Expires 1 Year From Date Issued { _ 4)ad ed <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 applicationismade in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND. - CATION.. ----ell f� ----- -----•---- <br /> tr <br /> Owner's Name Phone y <br /> ------ -- ------ ----------- <br /> /, ,jam ... <br /> 111 .-.. <br /> Address--------- ����' .�. J -------------------------•--------- <br /> Contractor's Name.--------- i -. ._.._ - c --..._ - -------- Phane '---­--------- <br /> Contractor's <br /> will seiv.e: :,Residence Apartment.House ❑Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> N <br /> . umber- umberof..liv..ing_units:._ Numberrof„be.drooms , Number ti_,,aths . Lot size-_------ - ... <br /> Water Supply: Public system ❑ Community system ❑ Privateepfh to Water Table ______-_ ft.! <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan;❑ <br /> r <br /> Previous Application Made: (If yes,date-------------- -----I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> 4 F <br /> (No septic tank or cesspool permitted if public sewer is availablee wifNin 200 <br /> �� t c <br /> Septic Tank: Distance from nearest welL________:_t.._Distance from foundation--------------------Material--- --------------------------------------------- op <br /> ❑ No. of compartments---------- -- - ----.�ize_------- - _--- _Liquid deptf--------------------------Capacity---------- <br /> �- <br /> Disposa ield: Distance from nearest well___ p_-_Distance from foundation.__-1.0-------Distance to nearest lot line_�r ________ 1- <br /> [ Number of lines____________-f-- -- ._ .r,_,___.__Length of each line________6a----._________.Width of french___._�----�___-__________-__ <br /> Type of filter material.__n ___._-Depth of_filter•-material____.. -��__--Total length_______ -67--`__________________ <br /> Seepage Pit: Distance to nearest well------------------.`Distance from foundation---_----------------Distance to nearest lot line_-.._________-._ <br /> ❑ Number of pits----------------------Lining material----_------------------Size: Diameter-----------------------Depth---------.------------------__--. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation._`_---.-_-._.----.Lining material.____- --_________________ <br /> Size: Diameter Depth------------------------- <br /> -- -----------------------Liquid Capacity_ ------ alS. <br /> Privy: Distance from nearest well------------------------------- <br /> -------------------Distance-from nearest building____ ----------------------------------- <br /> ❑ ----------- -Distance to nearest lot line------- - ---------------- --•--- - ¢ -------- <br /> ------------------------- ----------------------- -- ----- <br /> Remodelingand/or repairing (describe .---)--------------------- ---- ----- ------ -•- - --- 0-------------------- ---------- --/---------------------------------------- <br /> ---- <br /> -----------------•-•----------------- <br /> 3 r <br /> ---------------------------------------•----•-------------- ----------- ---------------------- == `.. <br /> Ltx - <br /> ---------------------------------------------------------- --- --- -------------------------------- <br /> ----------------------------- <br /> ----------------------...... - <br /> -------------------------------------------------------=-------------------------------------------------------- -- --------------------------------------------------------=------------------------ --------- <br /> I hereby cert6S. d <br /> 'ave prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances, Staterules and regulations o the San Joaquin Local Health District. r <br /> (Signed} - -- <br /> t -------------------------------------------- - --------- <br /> --------- Contractorrl <br /> By•-= = --� - ---------- [ ) t <br /> (Plot plan, showing size of-lot, location of system n r tion to w s, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------ '---------------------------------------------------- DATE---,�--/---fa --------------- <br /> ---------------- <br /> REVIEWEDBY------------------------------------------------------------------------------- ------ -------------------------------------- DATE---------------?----•-••-------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------- -----------------•------------------------------------------ DATE-----------------•----------------•-----------..-.--------- <br /> Alterationsand/or recommendations:----------------- --------- - ----- ----------------------------------------------------------------------------t-------------------------------------------- <br /> ----------------- i <br /> 1 <br /> s <br /> ----------------- ---------------=------------------- ----------------------• ------------•----------------------- -------- -----------------••----------------------- ----------------------------------------------- <br /> _ r . <br /> FINAL INSPECTION BY:. --- ----;;0! • ------- - ------------ Date � --� <br /> -------- - ----- ---------------------- <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,California Tracy,Colifor ' <br /> ES 9 REWSEO 8-59 3M 3-163 F.P.0 O. n <br />