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FOR OFFICE USE: <br /> ------------------ ---------------- ------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. .�l�_. r- � <br /> (Complete in Duplicate) <br /> Date Issued ./-17 <br /> ----------------------- -- <br /> --------_---- -._ I This Permit Expires 1 Year From Data 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. S"__f oil W-= <br /> Utz—C_4 . <br /> JOB ADDRESS ANDD LOCATION_- <br /> r '`� 0 __ misY -----------(�r-------- '-----�` .__ <br /> Owner's Name----_/r4flf -----fir / r ---------------------•------------- ----------------_------ ----------------------- ------------- Phone-- <br /> Address------JS..�-t;------• ---- ---------------_-•-------------------------------------------------------------- <br /> -------------------------------------•------------------------....__.. <br /> Contractor's Name------ - ------- Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House El Commercial railer Court ❑ `Motel ❑ Other ❑ <br /> Number of living units: --- ---- Number of bedrooms -------- Number of baths __./- Lot size ______ --.--1�t' ' <br /> Water Supply: Public system ❑ Community system ❑ Private P---D',pth to Water Table 6-- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravei ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date......... .......) No [Mew Construction: Yes <o ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> "~(No septic tank or cesspool-permitted-if--public sewer is available within 240 feet.),. <br /> �� Material----pf,' ��---------- <br /> Septic Tank: Distance from nearest well---r��_---__Distance from fours tion___- __ __ <br /> �✓ <br /> lia No. of compartments__-_�_-_ .._______.._5ize � 7/__ Liquid depth---- ----------Capacity--XAP �-- <br /> -- <br /> Disposal ield: Distance from nearest well_il--------Distance from foundation---1Q----------Distance to nearest lot line__'�5------___- <br /> Number of lines------/_---------------------- --Length of each line-----/Pp------------Width of trench......-gv,_ _------------------ <br /> Type of filter Depth of filter material --_l __----------Total length-----,lam____------------__--------- <br /> Seepage Pit: Distance to nearest well-------------- -------Distance from foundation--------------------Distance to nearest lot line__.__-_______._. i <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------.- ---Dept h....----------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_...--_.--_..___-----___________-__. O, { <br /> ❑ Size: Diameter---------------------- ---------------Depth----------------------------------------------------Liquid Capacity----------------------------gals <br /> . <br /> Privy: Distance from nearest well----------------------------------------------_-Distance from nearest building----_-.______-.-___________----.____----_. <br /> ❑ Distance to nearest lot kne---------------------------------- ---------------------------------------------------------- ------------------- ------------------------- <br /> Remodeling and/or repairing (describe) ----fes`' <br /> -•------------------------•------------------------------------------------ -------------------------------------------------------------------------------------------------------------------•------------------------- <br /> --------------------------------------------------------------- --------------------------------------------•-------------------------------------------------------- <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 <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) --------------------------------------------------------(Owner and/or Contractor) <br /> ----- -- ----- <br /> (Plot <br /> ---(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> }� 77� <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------�!-R.-O'---------- ----------------- DATE----- -----I _j L 6 ` <br /> REVIEWEDBY------------------------------------------------- ------------------------------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED.--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-------------- ---------- - - ---------- ---------------------- -----------------•----------•-•--------------- --------------------------- <br /> ------------------ ------------------- ---------------- - ----- -- <br /> - --- - <br /> Dat <br /> i <br /> FINAL INSPECTI BY:_ -- Q e._. /-:--010---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />