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FOR OFFICE USE: UR.�e/� 6 l /� GILI <br /> C/as-6P--- ------- �9. d <br /> APPLICAT_ I7?`N FOR SANITATION PERMIT Permit No. A�__�-. <br /> `- -- -- -- - l �• 1 (Complete in Duplicate) q <br /> � : Date Issued <br /> ---- - --- - - - ------ - � . sued <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 LOCATIO ---�h-- ! /_. --------- ---------------------------- <br /> Owner's <br /> .Name____ _ <br /> Phone <br /> Address---------c _. s <br /> - -----•------•----------------------•---- ---------------- <br /> Contractor's Name------------ <br /> -------------------- Phone------ - -- <br /> Installation will serve: Residence trApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _. .�__ Number of bedrooms _�_'Z Number of bathsI----- Lot size _.. _(- CTO <br /> - - ---- ------- ----------------- ------ <br /> Water Supply: Public system [Community system ❑ ` Private ❑ Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e-�Flardpan ❑ <br /> l <br /> Previous Application Made: (If yes,date........._... No <br /> New Construction: Yes ❑ No FHA/VA: Yes ❑ No E�l - <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--/sif_--- -_----.Material ___� - ----.- .--- <br /> No. of compartments---__.._ 2-----------Size---.--- C-�-x• `r--Liquid depth__-- ------- --------Capacity--- <br /> Disposal Field: Distance from nearest well.^- ----__Distance from fount <br /> dation-_10---.-------.-Distance to nearest lot line__--------_----_.. <br /> [� Number oflines-- ---------------------------__Length of each line-. ?G.`----------------Width of trench-.4".�_.._�_._.__________ <br /> i Type of filter material _ _ -0-4- -----Depth of filter ma serial----1_t !......Total length------- _b_--�..------�-----._ Q ! <br /> -- - . _.�._ .. . �l <br /> Seepage Pit: Distance to nearest well__��_--__---Distance�m foundation__1LV__-----__- Distance to nearest lot line_..------..- <br /> �� Number of pits-_,f1..........___.--Lining material-.-.-f -,PC-I' Size: Diameter._.__-------------Dept h.-- j_�- ----------_- <br /> Cesspool: "ti Distance from nearest well ----------------Distance from foundation----------------. ..Lining material----..._...-------------------------- <br /> . <br /> ` - --- ------------ Liquid Capacity..-.-------- ---- ___. <br /> gals.th__--____.-------.._ <br /> Privy: + <br /> Y Distance from nearest well------------------------------_-----------____._Distance from nearest building-____-_._.._-----..-.---.------_---------- <br /> ❑ Distance to nearest lot line --------------------------------- -------------------------------------------------------------------------- ----------.... - <br /> 4f <br /> Remodeling and/or repairing (describe):---- --- - --- -------------- --------------------------------------------------- -------------- ----------------------------------------- ----- <br /> -----------------------------•------------------------- ----------------------------- ----------------------------------------------------------------------------------- ._*L <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,:11rsand reg ulations f the Sa Joaquin Local Health District. <br /> (Signed) - ------- ---- - ----- -----•---------------------- -------- -----(Owner and/or Contractor i <br /> ) j <br /> Sy:•-------------------------------------------------------- ----------------- - ------ ---r ---------------------------------------(Title)-------------- -- -------------- ---------- --- - t <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t <br /> s <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ -- -------------------------------- ------------------------- -------------- DATE----y- �-----•------------- ----- <br /> REVIEWEDBY---------------------------------------------------- ---------- -------- ---- ------- -------------------------------------- DATE----- - <br /> BUILDINGPERMIT ISSUED-------- ------ -- ------------------------- -------- ------------------------------------------. DATE--- ----------------------- -- ------------------------------ <br /> Alterations and/or recommendations.------------------------- --------------------------------------------- ------------------- <br /> ------------------- ---------------------------------------------- --- ------ ---------- ------------------.__..----------------- ----- ------ <br /> --------- --------------------------..................------------------ -- --------- ----------------- ----------------------------------------------------- - ---- ------------------------ <br /> FINAL INSPECTION BY:----� z A157-2,1 c ,A_ Date--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hoxellon Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />