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FOR OFFICE USE: - #� /�Sly <br /> -'a fS77 -------- � g3�1 <br /> APPLICATION FOR SANITATION PERMIT Permit No. .1.�..-"-`_-.... <br />---------------------- -- -- ---------------------------- i (Complete in Duplicate) Sdr/7 <br /> This Permit Ex ares 1 Year From Date Issued afo 7 Date Issued .-__/__l' 1--- `. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstall the work herein described. <br /> This application is made in compliance'with County Ord'na e No. S49. <br /> JOB ADDRESS AND LOCAT ON. ----- -�L --------------------- -----•---------------..-..-------------•-•------•---------------- <br /> J `1 f <br /> Owner's Name--t�(rd__ --- -----------------------------•-------------------- ----------- Phone------------------ <br /> .... <br /> Address_----�f- a w--- -1-----------------------------------------------------------•------ - <br /> Contractor's Name--------� S T� - Phone------------------------- <br /> - ----- <br /> Installation will serve: Residence ❑ lApartment House`ff- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _-.?- Number of bedrooms 1,6-- Number ,Of baths -r— Lot size _-/�-- -------------------------------- <br /> Water Supply: Public system ER Community system ❑ Private []':'Depth to Water Table <br /> Character of soil to a depth of 3 feet Sand E] Gravel E] Sandy Loam ElClay Loam ❑ Clay E] Adobe tr"'Hardpan <br /> Previous Application Made: (If yes,date------------- -_I No P!r New Construction: Yes ❑ No R�t- FHA/VA: Yes ❑ No <br /> t <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (N septic-4a k or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi k• Distance from nearest well-----------------Distance from foundation--------.-----------Material------------------.----------.-------.---- ----. <br /> No. of compartmef nts---------- ---------------Size---------------------------- ---Liquid depth----------- - ------------Capacity----------------------- <br /> �] ,, <br /> Dispos r Distance from nearest well....- ------Distance from foundation---1 `100---.---.Distance to nearest lot line---- -.-... <br /> Number of lines---1-.-_�------ ---_-------Length of each line----/a_4_-`____�-------.Width of trench---. - H <br /> I -------- <br /> G'�4` Type of filter material-_7717a- -..---Depth of filter;material------ ----Total length--- v---------------------__----_- <br /> Seepage Pit: Distance to nearest well----------------- -- <br /> --Distance from foundation-------------------- to nearest lot line-----------------a4 <br /> ❑ Number of pits----I----------------Lining material----------------------.Size: Diameter-----------------------Depth---------------------------------V1 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-- --------------Lining material--.-..-------------------------------.. <br /> ❑ Size: Diameter_-- ------De th---------------:----------------------- -- Luid Capacity gals <br /> ------------------------- <br /> E L Privy: Distance from nearest well -:Distance from nearest building <br /> ❑ Distance to nearest lot line--- ------------------------------- ----=------------------------------------------------------------------------------------------------- 1n <br /> 40 .. <br /> Remodelingand/or repairing (describe)--------------------------------------------------- -----------------------•------------------•---------------------------------------------------•---- <br /> } <br /> 1 .. <br /> } �ir <br /> ! hereby certify that I have prepared this application and that theliwork will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and <br /> regulations of the San Joaquin Local Health District. <br /> (Signed)---- ------------------- ------------------------------------- - - ---------------------------------(Owner and/or Contractor) <br /> By: �e�--l.(---!---1j----------------------------------------------------------------------------------(Title)-------------_--------------- ------- - - .-------- <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> x FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY D � --------------------------------------------------------------- DATE----ell- f - —----- --------------------- <br /> REVIEWEDBY.--------'' -------------------------------------------------------------------------- ----I---------------------------- DATE----- ----------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------..--------- ---------------------------------------------------------- DATE------------------------------------------- ------------- <br /> r ----- <br /> Alterations and/or recommendations:----- ----------- -------------- -----------------------------------------------------•----------------=------------------------------------- - 0 <br /> --------------------------------- ---------------------------------------------- ------------------------------------------------------------------- <br /> ---------- -- ---------------------------------- --- #----------------------------------- ----------------- --------------------------------------------------•----­­------- ---------- ----•----- -------- <br /> ----------------------------- - ------ ------------- - --------------------•-•-------- ------------------------------------ -------- ---------------------------------------------------- <br /> FINAL INSPECTION Date--- 7.-- �� a --�-- - ------------- ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. ! <br />