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FOR OFFICE USE: t <br /> APPLICATION FOk SANITATION PERMIT Permit No. ---.- ,a"3y <br /> --------------- (Complete in Duplicate) <br /> ---------------- ---------------------------------------- <br /> Date issued <br /> -------------------__---__-----------------_--------__--- This Permit Expires 1 Year From 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..._ -__ <br /> ---------------------------------------------1---�-�----------- --- <br /> Owner's Name------------'? --c-- - ----------------------------- -------------------- Phone./[T __ - - <br /> Address-----------------------•--------1 / ------------------------------------------------------------------------------- ----------------------------------•------------------------------ <br /> Contractor's Name------------------- = ------------------------------------------------------------------------------------------•--•----. Phone----------------------------------- <br /> Installation will serve: Residence <br /> si [�Ipartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----I--- Nu ber of bedrooms -�-_ Number of baths ____[___ Lot size ---7Y �� <br /> Water Supply: Public system Community system ❑" Privafe ❑ Depth to Water Table c-,-,T-ff. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand nam ❑ Clay Loam ❑ Clay ❑ Adobe D-11'ardpan ❑ <br /> Previous Application Made: (If yes,date.............. <br /> ___.) No New Construction: Yes g,-110 ❑ 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 /> Septic Tank: Distance from nearest well----------------Distance from foundation--------------------Material------ ------------------------------------------ <br /> No. of compartments--------------------------Size---------------------------- Liquid depth------------- Capacity----------------------- <br /> Disposai field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line___.____-__.__--_ <br /> 46"1 Number of lines-------------------- - -----------Length of each line------------------------------Width of trench-------------- •----------------- <br /> Type of filter material________________________Depth of filter material----------- Total length________...________._____�--_____ %.31 i <br /> Seepage : Distance to nearest well___.���------Distance from foundation_./©.,"'"..___.Distartcg to nearest lot line--- <br /> _____.Linin material__ �a:-CK�.._-.Size: $iar�e#a _ ��.___._-Depth...7-'----__--______.______ �d <br /> Number of pits__-___- --�-__ g <br /> Cesspool: Distance from nearest well_________________Distance from foundation..------------------Lining material_...-__....._-_.---------_-__--_____. <br /> ❑ Size: Diameter----------------------------------- -Depth- ------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------- _____________ Distance from nearest building___._.___.._________________-_.____.___.. <br /> ❑ Distance to nearest lot line---------------- ------- --- ----------------------------- ---------- --------------------- ----------- ------------------------------------ <br /> Re odeling and Qr repairing (descrr-oe):_ fG' _ _ ~' <br /> --------------------------------7----- -------------------------------------------------------------- <br /> 1-C 11a <br /> -------------------------------------------------------••-------..-.--------------------------------------------------------------------- --- <br /> ------------------------------------------------------------------------ <br /> - -- ---- ------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ISigned)----------------------------- --- ------------------ (Owner and/or Contractor) <br /> Ow <br /> BY ------- {Title)--------------------------------------------- <br /> -------------------- ---- ------ -�---- -------- <br /> (Plot plan, sho ng size a , location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ---------- ;6 "- <br /> ----- - -------- ------�---- - ---------- ----------------- DATE------ ----M---------- <br /> REVIEWEDBY--------------------------------------------- ------------------------------- - ---------------------------------------------- DATE------ ---- ------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.---.----------------------------------------------------- <br /> Alterations and/or recommendat' ns:---------------------------------------------------------------------- <br /> ---------t ! = ..6511-<P------------------------------------------ ' <br /> ----------------------- --------------------------------I- ------ ---------------------------------------------------- ---------------- --------------------------------------------------------- <br /> FINAL INSPECTION BY:------—ae----- --------------- Date....Z_r'Z —t:,� <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.C E3. ►�' <br />