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FOR OFFICE USE: <br /> --- <br /> ------------- -- ------ --- APPLICATION FOR SANITATION PERMIT Permit No. ._I�._ •=..-.1/�SJ <br /> (Complefe•in Duplicafel <br /> --- ----- - ----- -------------- This Permit Ex fres 1 Year From Date Issued <br /> Date issued ___�-�5--�,� <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 /> , �- <br /> Owner's Name----------- <br /> ------------- <br /> A <br /> Address_. <br /> ----------------------------- Phone--- <br /> --- <br /> ------------- <br /> il . ______.__ontractor's Name_ a <br /> ------------- -------------- ------ ------ ------- <br /> --------------------- -- <br /> -- ------------ Phone------ ------------ <br /> Installation will serve: ,Residence F—Apartment House ❑ Commercial' ❑ Trailer Court ❑ Mote! ❑ Other <br /> Number of living units: .j--- Number of bedrooms ❑ <br /> __._ Number of baths Lot size _._ <br /> 0 <br /> Water Supply: Public system ----�•----- ---------- ------ <br /> r Community system ❑ Private ❑ Depth to Water Table /S--ft <br /> - <br /> Character of soil fo a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Er Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Applicafion Made: (If yes,dote_. ) YNo <br /> :: „�i_,NewEGonstru_ct_ion: Yes ❑ No �HA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: � � v <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._.___-.__ . `\ <br /> ���•� Material --. ---- . <br /> � t r�G No.+ of compartments______________•.- -' <br /> Size---------- <br /> -----------Liquid depth- ------------- --------Capacity------ ------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation---._--- ---__ <br /> C���- Distance to nearest lot fine_________________ <br /> t IK�:. Number of lines----------------------------------Length of each line__.------------ --_-- ' <br /> -----�--•�* h.-. <br /> 4 TOtdI, length_... <br /> ,i t of trent <br /> Type of filter-material__. `;'Depth of filter material--=----------------- y, <br /> - •---------•----•--- <br /> Seepage Pit: Distance to nearest well_. ��-�.- :Distance from foundation_- <br /> ' �7 112---------- to nearest lot line_.__..____-- <br /> [� Number of pits --- ------ ----Linin materiaL�7Gl'(---- t f[ , <br /> 9 _ . . Size: Diameter'_:-.:------- ..Depth-- -`----- ---------- ------ i <br /> Cesspool' Distance from nearest well ---------------- from foundation._....:_i..__'_ . Liriing raateriaL_._.._--- _ _ <br /> ❑ Size: Diameter- -- --------- --: -----------:`----Depth------- � � L•q4 id -•--- <br /> --------------- -------------- - ------gals. <br /> -_ � u Capacity--=----- --------- �- <br /> Prrvy: Distance from nearest well------------------ --_------------------`. �Distance from anearest buildin <br /> - ----- <br /> ❑ ------- <br /> Distance to nearest lot line <br /> ---------------__ --------- <br /> ------ --------------- <br /> F <br /> Remodeling and/or cepa{ring <br /> { <br /> { 1 •�. 3 r tt.t i-'-3L i <br /> -------------------------- ------------------------- ------------• ------.. ---- ­­ <br /> ------------- <br /> k <br /> C �1 I -------------------------•------------------------------- <br /> --- -----•-- - ------------�L J-- i <br /> I hereby certify Chef I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Srza-14- 2", <br /> aws, 'a rules -Jd r g lotions f the n Joaquin Local Health Disfricf. <br /> (Signed)- a, 1 <br /> } _ ----- -------- w and/or Contractor) <br /> g P <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildin 's, etc., can be laced an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- ------- ----------- -------------------'--------------------- <br /> DATE----- <br /> REVIEWED BY <br /> -------------------------------- --- <br /> I -------- DATE------ <br /> ---------------- <br /> BUILDING PERMIT ISSUED-------- -- -------------- ---------------------- - - " -------------------------------- <br /> ------ ----------- DATE -t <br /> Alterations and/or recommendations;_ .............. ...... -- ------- -- <br /> _ l <br /> _ - --`-------- <br /> -------- •------------------- <br /> - -------- , <br /> ....__. <br /> -------------- --- <br /> ------ - -- ----- ---- - <br /> --------------- <br /> FINAL INSPECTION :_.. <br /> '_ �6 .__ - 4� Date----------- <br /> ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave, 300 West Oak Street <br /> . 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca, California <br /> E.H.9 2M 1-67 Vanguard Press Tracy,California <br />