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VUK UVVI Lt USE: - <br /> ____ _____ - 3 U APPLICATION FOR SANITATION PERMIT Permit No. ....1__�.�#. _3._ <br /> - {Complete in Duplicate} <br /> - ter- <br /> .......... This Permit Expires 1 Year From Date Issued Date Issued ._•-___--- <br /> Application is hereby made to fhe San Joaquin Local Health District for a permit to construct and instalf the work herein�dQ�ib� <br /> This application is made in compliance with County Ordinance No. 549. <br /> >tl�J7 E'. fk/ <br /> JOB ADDRESS AND LKATION----- ------------- <br /> _____ '� t <br /> -------- --_.._... <br /> Owner's Name............. 11 <br /> 1 �... 1`1-L�.7r - z - _h �V -l�'�'- one°-`"``'f—� <br /> Address----•----------- cc <br /> Contractor's Name------..Rp Phone <br /> -- --- ------ --------------------------------------- •-• .............. <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court 5]--Motel ❑ Other ❑ <br /> Number of living units: ........ Number of bedrooms ......_. Number of baths -------- Lot size -------.._._....._9 -[L J4------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private epth to Water Table � f_ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (If yes,date........... -------) No New Construction: Yes [] No FHA/VA: Yes ❑ N6-E� <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 1 <br /> Disposal Field: Distance from nearest well.................Distance from foundation,............-------Distance to nearest lot line_..---------____- <br /> ❑ Number of lines__..__-_-_......:............__.Length or each line--_------------.._..-- -------Width of trench___._.._._______._ <br /> ype of filter material....... ................Depth of filter material....------------------_Total length_.-------------------____--._-___...___-_- <br /> SeepEL-age Distance to nearest well../!0_'3 -" Distance f m foundation_,1�_...___...Dis aaynce to nearest lot Iine.,5.- <br /> < Number of pits...... Lining material_._�.c_ .-Size: Diameter_-.�(l .��._--DepthO�oC��71_� <br /> Cesspool: " Distance from nearest well..............__Distance from foundation....----------------Lining material-------------------- <br /> ___...-----. <br /> ❑ Size: Diameter----- - -------------------------_-.Depth---- ------------------------- •--------------Liquid Capacity-. ----•---------------...gals. <br /> Privy: Distance from nearest well.............................- .... Distance from nearest building..._ <br /> ❑ Distance to nearest lot line----------------- <br /> - �---------•---------- -- <br /> ------- <br /> -----------'--------------- <br /> --------------------------------- <br /> Remodeling and/or repairing (describe)-------------------- ( ,( 9 ., _ <br /> "'"_.`-aJ'�• ------------------------" v <br /> _--------------------------•- ------------------- ----------------•------------------------------------------------ <br /> ---------- •.............•..-.---------------•---------------••--------------- ----------------------------------------------------•-•-----------------................... <br /> ---------------- -------'-' ---------• .....................................•- ------------------••-----------....--------------•- --------------------------------------- ---------'....................­ <br /> f hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State Igwd rules and re ions of the San Joaquin Local Health District. <br /> {Signed) ---- - -- . . ................... � <br /> --- -......... . --"--------------------- ------ (Owner(Owner end/or Contractor) <br /> By:-------- •------' ` '---------- <br /> (Plot <br /> ......(Plot plan, showing size of Io_ Iota ton of system in relation to wells, buildings, eta, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.._. 1 -........ ~---------•--------- --------------- -- DATE........ <br /> REVIEWED BY... ................ ------------ --- DATE <br /> .............................................. <br /> ----------------------------------'--------- <br /> BUlLD1NG PERMIT ISSUED--------------------- ----------------- --------------------------............................._. DATE...-•---•-------------- <br /> ..Cera+io�and/or r�omtren�+io sG �1 ------------------ --- :..--.... - - <br /> !�� ...................... .....•......• •-•------------------------•--------------- <br /> ----------------•----•---­------­------------------ .......------------.......-....----------•---------------- -------...---------------........ <br /> - ....................................................................................... .................................._........................................... - <br /> .............. --------------- ................. ....................................---'-----------.....'....................................................... <br /> FINAL INSPECTIONBY:.. cs � _- <br /> -- ...-•- - -- -- - ---.. .--�--- Dote------- <br /> SAN <br /> -- - -SAN JOAQUIN LOCAL HEALTH DISTRICT o <br /> 1601 E.Hazetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Colifornfa Lodi, California Manteca,California Tracy,California <br /> [5 9 Rr.VI&ED 8-59 3M 3-'63 r.P.Oa. <br /> t+ <br />