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FOR OFFICE USE,: it-14------------------- <br /> APPLICATION AOR SANITATION PERMIT Permit No. <br /> - _ <br /> -- ----------- . (i;,�rnplete in Duplicate} • ff S <br /> ___.=-_ This Permit Ex ires 1 Year From Date Issued Date Issued ._l._7__-__�-._-_ <br /> Appli4ation 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 /> JO8 ADDRESS AND LOCATION_.-___�I�_ � 1,� <br /> _ -C'1- _. = •- -'-------------------------- <br /> Owner's Name------- ----------------------------------------------- ---------- --- - -------- Phone--= <br /> Address--------------7_jjQ_----- �t--l-C'-----A-V.-E.............. <br /> 1 <br /> t R -----------------....... <br /> . .Contractor's Name-----------------O'_(iC 7.i - ---------------------------------------------------- -------------------------------------------- Phone- ---Zk-6- ---•------- <br /> Installation will serve: .Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -]----- Number of bedrooms _3__ Number of baths -------- Lot size ----------------------- <br /> Water. Supply: Public system ❑ Community system ❑ Private r" Depth to Water Table v'30._ ft. <br /> r" <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Applica4ion IViade: (If yes,date- ------- ----------) No New Construction: Yes M No E] FHA/VA: Yes E] No <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-,.SD_-----__Distance from foundation-_-A-0-----.---Material.- " ________________._. <br /> No. of compartments_-__-.._ 2------------ Liquid depth--------- Capacity._ L-2--bb <br /> Disposal Field: Distance from nearest well..-S--Q------._Distance from foundation------e'_(?___--_.Distance to nearest lot line_ <br /> ® -~---Number of lines-------,X4------ --------Length of each line__fT9J"r_-20 of trench------------------------- .-------- <br /> Type of filter materia;____�-----------Depth of filter materia l-------�--'.-----__.-Total length <br /> ___-_-2__V -___.___________________ <br /> Seepage <br /> Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-.__.____-____-_ <br /> QNumber of pits------------------ ---Lining material-----. ------- .------Size: Diameter-------------- -.------Dept h---------.-----------.----------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----------------_ - Lining material---._-._...___..______.._ <br /> ❑ Size: Diameter- -- -------- Depth___It'...- -----------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------ _____Distance from nearest building-__._- .__.__-_.__---_------------.-_-... <br /> 0Distance to nearest lot line__ --- --------------------------- --- ----- ------------------------------------------------ --------------------------------- ---------- <br /> Remodeling and/or repairing (describe)------- ------------------------- --- - ---------------------------------- _------------------- -------------------------------------------------------- <br /> ----------------------- -------------------------------------- --------- --------------------------------------- --- -------------------------------------------------------------------------------------- <br /> - ---------t..­---------------------- -----------------------------------------------------•------•----------.._..------- -------•-------------- ----------------------------------------------------- ..... <br /> ----------�------------------------------------------------------------------------------------------- --•---------------------------------------------------------------------------------- ----------- --------- C <br /> L hereby certify that I have prepared this application and that the work will be done in accordance-with San Joaquin County -!Z <br /> ordinances, State laws, and rules and regulations �thheSanJoa in Local Health District, r <br /> (Signed) - �f-- -------�--- - -- - ............. <br /> -- --- . ............ <br /> ......... <br /> .(Owner � <br /> r <br /> By:---------------------•----------- ----------- -- ----(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--7 " ------/----7 <br /> REVIEWEDBY------------------------ --- - - -- ---------- ------------------- ---------------------------- ----------------- DATE------ --------- <br /> BUILDING PERMIT ISSUED-------------------------------------- ----_.------ ----­­-- -------- ----- DATE_ --- <br /> ------------- <br /> ------- - <br /> ------ <br /> Alterations and/or re ommendations:_..1-4G..-._ __� -_____._� <br /> ---- � sfe - -------------------------------- <br /> ------------------------------- --------------- -------------------------------------------------------------------------------------------------------------------_-------------------------------------- ----------- <br /> --------=------- ------------------ --- ---- - --- - -------- -- ---- --- ---- ----- ----------------------- -------------------------_--------`---------------------------------------- <br /> FINAL+ INSPECTION BY:.- - � - Date-- ------ ------------- -- --- ---- ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 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.CC. <br />