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FOR OFFICE USE: <br /> ------------------------_.--._-___-_--__--.__-___- APPLICATION FOR SANITATION PERMIT Permit No. .c __d�F <br /> ------------------•---------------------------------------- (Complete-in Duplicate) <br /> Date Issued <br /> ------------------------ -------------------------- ­_ This Permit Expires 1 Year From Date Issued <br /> 14, <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. pr - p7o —rZ <br /> .�y cam, <br /> ,r� 0 <br /> JOB ADDRESS AND'LOCATION.. _ .�r�_ _!--*,tom. � °Yl _________ <br /> _ <br /> ------_ <br /> ---Owner's Name ✓ Phone. <br /> Address------ <br /> e t - .. ----- --------------------------------------------------------- -•------------ <br /> Contractor's Name------ -------------•------• - -- --------------------------------------- Phone..---- -------••------- <br /> Installation will serve: Residence N Apartment House [ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J----- Number of bedrooms __�__ Number of baths 3.._ Lot size ----1.3 -_ -- - -1__________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Tablep_ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> r <br /> Previous Application Made: {lf yes,date________ __________ 1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-4.p........Distay fro foundation__>E�_.__._.-_...M teriai _nf-lt �f------------ ---- <br /> No. of compartments i��'# Liquid depth --- ----- P ty��.66---- --- <br /> Size_TT._-x_._ rr_- Ca aci <br /> Disposal Field: Distance from nearest well.S_-�?_..--....Distance from foundation---/_Q-----------Distance to nearest lot line---15........... `� <br /> f4 Number of lines-_._�--------- ------ ------Length of each of trench--_ .0-------------------- <br /> 0 <br /> Type of filter material-,&)p............:_Depth of filter material---. --.-.-.--.-Total length-A-44_4------------------------------ <br /> Seepage Pit: Distance to nearest well__ ___________________Distance from foundation___-_..___--.._-_.Distance to nearest lot line-------.--.-_---_ <br /> ❑ Number of pits--- ---------------_-Lining material---------------------- Size: Diameter------- --.------.---- Dept h--------------------------------- <br /> Cesspool: Distance from nearest well ------------.,--Distance from found at ................. ..Lining materia#-----__.:_.--.______...._____.___. <br /> ❑ Size: Diameter- -- --------- ----- ---------- >_:.Depth----------------------------------------------------Liquid Capacity- ------------------------gals. <br /> Privy: Distance from nearest well------- _._._-................... .......Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line ........::.... •----------------=•=----------------------------.._.--------------------------------------------- ---- <br /> Remodeling and/or repairing (describe):------- --------------------------------------------------------------- ------------------------------------ ----•--•-•------------------------------ <br /> -----------------------;----------------------------••----------------------------------- •------------------------------------------------------------------------------------------- ----------------- <br /> I hereby ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, a laws, and rules an regulations of the San Joaquin Local Health District. <br /> A/ 1Z1. ' <br /> {Signed . - -----(Owner and/or Contractor) <br /> By: •-••-------- -------------------------------------------(Title)----------------- ------..----- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -- - -- W -- ---------------------------------------- DATE__.7-!Z7e_-........ ---------- <br /> -- --------------- <br /> REVIEWED BY--------------------------------------------- ------------------- ---------------------------------- DATE------------•--- <br /> . ----------------------------- - --------------------------- <br /> BUILDING PERMIT ISSUED-------- -- --------------------------------------------• -------------------------------------------- DATE---------------------------------- <br /> Alterations and/or recommendations----------- .............. ,----------..-------------------------------- ----------- -------------------------------- <br /> - -------------- -------- ---------------------------------- ------•--------.-------------- ---------.. -- . . -------- ---------- --------------------------------- <br /> FINAL INSPECTION 13Y: ?" Date'/J----- -- ----------------------- ---- <br /> --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Sfreet 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br /> es �c <br />