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r FOR OFFICE USE: <br />------------------- =----•----•-------- ------------------- <br />......................................................... APPLICATION FOR SANITATION PERMIT Permit No...l_.�_c{'a��5.:... <br />------•.............•-•---•---. -- ...------ . (Complete in Duplicate)// �� <br />........................................................ This Permit expires 1 Year From Date Issued <br />Date Issued .9,1.E J' -•-Y <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 a plication is made in compliance with County Ordinance No. 549. <br />JOB ADDRESS AND LO ATION_________________U�_4�t..__.t___.-------------------------------------- <br />Owner's <br />O�3— os---1� <br />..._ - --- _- <br />Owner's Name--------- Com' -------•-------------•--_- Phone ....... -------------------­ I ...... <br />Address............................. ------4----/---- <br />•---- -•-- - -._..-..-•------- <br />------------------------ <br />- 7 <br />Contractor's Name, _l ,�Flr- ----- Pl.-g&iL� <br />Installation will serve: ResidenceA Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Ofiher ❑ <br />Number of living units: _1..... Number of bedrooms __ _._ Number of baths X-•:.._ Lot size 6.T3 _ .7 j ................................... <br />Wafer Supply: Public system ❑ Community system ❑ Private, Depth to Water Table 6_S -ft. <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,R Clay ❑ Adobe,P Hardpan <br />Previous Application Made: [If yes,date....................) No M 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 />f <br />Septic Tank: Distance from nearest well__r�V-f o� foundation---- ��--------.Materiaf_.�!��.. <br />No. of compartments..................._Size__F,---•.�. __�'J�___:_--Liquid depth--._. Capacity./,_"-..___-___ <br />._ f..------•-- ------ <br />Disposal f Q.'.;___.._.Distance to nearest lot line ... <br />Dis osal Field: Distance from nearest weli._ _ �....._ ..Distance from foundafiion_. ___ <br />Number of lines ------ _ _._ __._ _---._• .-Length of each fine-__ D -b© Width of trench. _..��__.____..________________ <br />Type of filter materia sa.�_-Depth of filter material.__:_T'._-------- Total length__.,%.l_________........ <br />Seepage Pit: Distance to nearest we 1/-"- �_.__._.D- t n�e to neo jest lot li r ............. <br />Number of pits..c�_._....-_._. Lining material]•1/'G'�?._-------- Size: Diameter:-...�-------- -- Depth --.._,2^.0 ---_________________ <br />Cesspool: Distance from nearest well.................Distance from foundation .... #........ .-_...Lining material ...... ....................... <br />.__..... <br />El Size: Diameter .... ..............- ........_........Depth------ •----------------•---••---.. - _--_-------. Liquid Capacity ........................... -gals. 0 <br />c <br />Privy: Distance from nearest well_____________________ __________________________Distance from nearest,,. building _._..------------ ...... ...-........... •K <br />❑ Distance to nearest lot line .............. -..--••---•---------------------------•------------------ ...........-.......- /+per <br />ie �i: l <br />Remodeling and/or repairing (describe)------ ------------••-----------•------------•---•---------•------• - ' <br />----------- --•-•-••------------------------------- --------.------•----------..-•--...._._............... --._.-- --•------------ <br />------------------------- ..------- ----I----------- ----------- ------------------ ••-------------. •------...._-..-----•----------------------------••--------------•--------------•------ ------- <br />I <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 f ws, and rules and regulations o the -San Joaquin Local Health District. <br />__ <br />_ ____________-_--.____-_(Owner and/or Contractor) <br />Y• ---------- ------•-- _.......----------_----------• •----•--•--------------------•---------- <br />(Signed)-�'�..... - • •-•--�-=�-••'/-------- -- •- ---- <br />B ' ' --- <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 />Al <br />APPLICATION ACCEPTED BY.... ........------------- ------ ----•- =........... --•---------- DATE..,--� <br />REVIEWED BY ......... <br />------------------------------------------------------------------- •------------ ---• ........ DATE.......... ........................... <br />.. <br />BUILDINGPERMIT ISSUED ............. .................... .......•--------------...---•------------------------ *.... .......... DATE ------ ......--------•------------------- <br />Alterations and/or recommendations:.,...----•---.....--•-------•------•-----------------------------------•-------------------------- ---------------------------------- •------- ---------- <br />------.-----•- •---•...............•---------•--------------- •---------- --- . ------ ------------------------------------------------------- •---................. ............. --- --•--•................ <br />--------------•.......................... .--------------•--------- ----------------------- ­­ .....-........................................ ---------------------------------------------------- <br />FINAL <br />---------•------- ------ -----FINAL INSPECTION BY r'.aIQ 1 f ---------------- --- -- Date... J/ ..tP �f <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. llazellon Avv. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES 9 REVMCP 6.59 3+n 3-•63 F.P.CC. <br />