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FOR OFFICE USE: <br /> --int-------�-=-Ou--�="-ti--------------------------- <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..,1 _ ._ 4 <br /> ------------------------­_ -------------------------- (Complete in Duplicate( <br /> This Permit Expires 1 Year From Date Issued 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 co" liance with ounty Ordinance No. 549.qq <br /> [_1-bcharat - .11.. - ---l..i P C�-----am- <br /> ------------- <br /> Q-m L�`Ql,.v1tI1. E'WS <br /> JOB ADDRESS AND LOC TION______________________ __I-__��______._�.�_____ � �- [. <br /> Owner's Name------------ _A r:m�..� � �a'------------------- ---------------------------- Phorte../� �` ���� I <br /> Address--------------------------------_----�� ----.3d_ --__--�;.5-+jo-------l—��r�r ---------------------------------------------------------------------------------- <br /> Contractor's Name------•--_-----••--•-------0 ^ e-'<——---------------------------------------------------------------------.._...... Phone----------------------------------- <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -I_____ Number of bedrooms --2- Number of baths ___/___ Lot size ----------------- __._a_C___t_____-________________ <br /> Water Supply: Public system ❑ Community system ❑ Private$6 Depth to Water Table _....__. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam'( Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Ilf yes,dote----------_---------) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ NoX <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if publics ewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_5,0.�4'ILh_Distancje frorq foundtion_la__I)l___.Materi ai_.__4�t � ___ w 'F <br /> No. of compartments------9-----{-__f---Size_3__)(_Q.__)(�-----Liquid depth--------_#--------------Capacity----!3d0f <br /> Disposal Field: Distance from nearest well__5-P-lht k�Distance from fou ndation__IQf_&{-!ti`__Distance to nearest lot <br /> Number of {ines--------------�ct __________i Length of each line----------� _f�-.-._...Width of french________o�__ _____________-___ <br /> Type of filter material- - f_-�4ck Depth of filter material_____1.1_._.________Total length_______I_ ..................... D <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line---------....... <br /> . <br /> ❑ Number of pits-------_2-------------Lining material-----------------------Size: Diameter-----------------------Dept h----------_-.---.----------_----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------.-___-___- <br /> ❑ Size: Diameter------- ------------------------------Depth--------------------------------------------------._Liquid Capacity.---------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------.--------..-___._. <br /> ❑ Distance to nearest lot line--------- ------------------•-------------------•--------------•---------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):---------(1_&*'-------�T-�-sle-le- m)----------------------------------------------------------------------------------------- <br /> ----------------------------------------------------••----------------------- -------------------------•.--------------------------•-------•---------------------------------------------•----------------------------------- <br /> I 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 nd rules and regulati s of the San Joaquin Local Health District. <br /> � a <br /> (Signed) ---------------(Owner and/or Contractor) <br /> B (Title)_ . <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------------------------------------------------------ DATE J <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------ ---------- --------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------------- ------------------------- <br /> Alterations and/or recommendations:----------------------------------------------------------------------------------------� = <br /> --------------------------------------------------•-.------•----------------- -----------•-------------------------------------------.._..---------------------------------------------------------.-----•------------------- <br /> ---------------- <br /> - <br /> ----------•---------------------------------- ---------- ------------------- ---------- ------------- ------•----------•-----------••--- ---•--------------------------------------------------------------------.--- <br /> FINAL INSPECTION BY:------0--'------�,o ------------------ --------------- Date-- = j..lc[ ------ -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES•9 Rrvisro 9-69 r.P,oa.2M 6.6c <br />