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E FUR OFFICE USE: <br />! ----------- - ------- <br /> _. { <br /> ----- --------- APPLICATION ,FOR SANITATION PERMIT Permit No. ................. <br /> --------- ----------------------- (Complete-in Duplicate) <br /> --- -- --------- ........ This Permit Expires 1 Year From Date Issued Date Issued ------------_.._______ <br /> ThApplication is hereby made to the San JoaquinM,61 Health District for a permit to construct and install the work herein described. <br /> is application.ris,.made-.-in,compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.__/ Ot ' <br /> ✓ -------- om _ 2�0��a <br /> , ' ' <br /> Owner's Name._._�,�,-- _ - ---- ----------------------------- <br /> ��Phone -- ------------------------- <br /> �,++ rr ­ r, <br /> Contractors Name__e!.._1-------- -------- -------------- ------- -------•------ Phone------ --------------------------- <br /> Installation will serve: Residenceartment House <br /> p ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ <br /> Number of living units: __(_____ Number of bedrooms _..1-. Number of baths __-I___ Lot size .--6 -----�,. �� .-............... } <br /> Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table AA_�_f+ s <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [� Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: {If yes,date------------- I 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_________________Distance from foundation-------------------Material ..___.-_-__.._ <br /> ❑ No. of compartments--,------------------- Size------------- ------ -----------Liquid depth..------- -- - - --------Capacity--------- - --------- <br /> c <br /> Disposal Field: Distance from nearest well.-J.:17:1...Distance from foundation-- - '-- Distance to nearest lot line__: -C7 F <br /> Number of lines_______-_ /- j� Length of each lin e__.__�_f.� <br /> ----_-_.._--- -Width of trench.... <br /> Type of filter material- _-_-:_-.._Depth of filter material.__.f-__.________Total length_-fo_ --------------------------------- <br /> Seepage Pit: Distance to nearest well `_._.__Distance from foundation--------------------Distance to nearest lot line__. <br /> ❑ Number of pits--- -------------- Lining material ----­-------------- Size: Diameter-------------.---- <br /> ----Depth -------- ------------ ------- � - <br /> Cesspool: Distance from nearest well s_______________Distance from foundation-----------------_Lining material_-.._-__- ; <br /> ❑ Size: Diameter_ __ ________ _ ___ _ Capacity1 } <br /> ------.Dep+h Liquid - ------ --------------gals. <br /> Privy: Distance from nearest weH-----------------------------------------------.-Distance from nearest buildin <br /> ❑ Distance to nearest lot line -------------------------------------------.---------------_- <br /> Remodeling and/or repairing (describe):-----__----- , <br /> -----•-------------------------------------------------------•---------------------- <br /> -------- <br /> ---------v--------- ------ ----------------------------------------------------------- --------- --- -- - ----- -- - <br /> - - - - - - - - - - - - ----------- - - - -- --- -- - -------------- - - - - - <br /> ere y certify that I have 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. <br /> (Signed)------------ -------- r <br /> --------------------- --------------- - ------------------ --------- ------------ -(Owner and/or Contractor) <br /> By:-------------------------------- ----------------------------------------- --------- --- - *- <br /> Title <br /> -- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._. -!- _ �-!�c�---- - - ----------------------- ---------- DATE.- - -'/- 2---. <br /> -- -------6_.?.----------------------- <br /> REVIEWED BY - --------- ---------------- ----------------------- --------- ------------------------- DATEE----- <br /> UILDING PERMIT ISSUED----------- -- -----------------------------------------•-- -- ------------------- -------------• DATE----- <br /> Alterations and/or recommendations:......_..._-- - <br /> ------------------- -------------------------- ------------------- - ------------------------------- a <br /> -------------------------------------•------------ - •------------------ ------------------- .------------------- <br /> ------------------- ---------------- ------ -------- ----------- -.....----------------------------------- -- ---------------------------- ------------------- -------- --- ------- <br /> -------------- ------- _ <br /> --------- - - ----------------- ----------- <br /> ------- <br /> e - --------------------------------------------------- ----------------------- -------------------- <br /> FI-NAL <br /> --------------------F1.NAL INSPECTION ............. 7-12— 1/ <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 911%Street <br /> Stockton,California Lodi, California Manteca, California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> i <br />