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FOROFFICE USE: <br /> ----------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __ZZ2�---(Complete in Duplicate)- <br /> Date Issued <br /> --------------------- This Permit Ex fres 1 Year From Date Issued <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. <br /> JOB ADDRESS AND LOCATION_-r-___ Ac -------/Ma <br /> 1 ---- ------- ---- <br /> ------------------------------- <br /> Owner's Name -------------­--------------------- ------------------------------------------I.. Phone------------------------------------ <br /> Address------------ <br /> Contractor's Name-----C&ZO&I----3-----7-,s----- ------ Phone-.-•---•---------- <br /> -- ----------------- -----------------•----------••------------ ------------•--- <br /> Installation will serve: Residence ®—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1__- Number of bedrooms Number of baths 9-- Lot.size --- _ RC1 <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _4ft. <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,dote-----------.--------l No qr New Construction: Yes �o-❑ FHA/VA: Yes ❑ No [4 ---.-. <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- F <br /> p �=_-t.__Distance from foundL]ation_� __________..Material__���� �g„------------------- <br /> No. of compartments-_-.9-------------------Size__�'�X__9gC _--Liquid depth----_�__'__--- ---.Capacity--- 1:7r� <br /> .Disposal Field: - Distance from nearest well -0-'a Distance fpm foun�ation__lQ---'______..Distance to nearest lot line_�� �___ <br /> ------- -- _ Lef tbr'C -eae i I ne_ ". -----------.Width <br /> Number of lines------"------- ------- <br /> Type '� Depth of filter material-AY-_ <br /> T e of filter mafierial_ 1--0�-__-----_ '` Total <br /> �rR <br /> Seepage Pit: Distance to nearest we!!--------------------- <br /> `Disfance f�om-founda#ion___._____.•-._..-_.Distance to nearest lot line----------- D, <br /> ❑ Number of <br /> pits______________________Lining material----------------------- Diameter__--__-_--____-__.__-Depth_______--___-_-_----__-_ <br /> Cesspool: Distance f3om nearest well-----------------Distance from foundation__------------------Lining material______-__________ -_____------------- <br /> ---- <br /> '- te' <br /> ❑ Size: Diameter - Depfh_---------------------------------------------------Liquid Capacity-- ------- ..gals. <br /> Privy: Distance from nearest well______------------- <br /> ---------------------------Distance,from nearest buildin <br /> a ,.. _ 9 ---•--------------------- <br /> ❑ Distance to nearest lot line - ., Q <br /> ---------------------------------------------------------------------- <br /> Remodeling and/or repairing '(describe)__________________________ <br /> ----------------------------------------------------- ---------------------- <br /> ------------ <br /> ` S <br /> __________________________________________ ______________________________________________________________________________________________________________________-_-________________-____________-______-_-___-_-.-_-.-_ • . <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, d ules and regulations of the San Joaquin Local Health District. <br /> (Signed) r--`— <br /> .�- ,._. _..�.: ,; V and/or Contractor} <br /> By ------------•-- _ _. <br /> -- ---- ---------- = (Title)-, t <br /> s (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> f # FOR DEPARTMENT USE ONVf <br /> APPLICATION ACCEPTED BY : . l-- DATE° r <br /> ------ ------- -- <br /> REVIEWED BY - ----------------- -- DATE------ --------------------- . <br /> UILDING PERMIT ISSUED --------- - ----- DA•TE <br /> -- ------------------------------ -- - - <br /> ------ <br /> Alterations and/or recommendations:__ ---_--- <br /> :�:_�_ <br /> ----------------------------•--•----------- ---------------------------- <br /> -------------- <br /> --------------------------_______________ <br /> ____________________________________________________________________________________ .J <br /> ------------ <br /> ____________________________________________________________ _____________ <br /> ___--------------_____________________________________________________________ ________ <br /> ________________________________________ --._i -_ _..-lJ,f__!1_____'_.._.__ - _-__--__._-___--_____-___-_--_-________-______--. ------------------------ <br /> FINAL INSPECTION J� �{11 � Date-------- �� <br /> w Ii <br /> /2 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelten Ave. 300 West Oak Street 124 Sycamore Street k 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 5.59 3M 3-'63 r-P.CD. ^ <br />