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1-UK UrrICL USE: <br /> ,3=� ------ -----P-------- ,. _ <br /> --------------------------------------- ________________ APPLICATION FOR SANITATION PERMIT Permit No.f14r J~`5. <br /> - ---------------------- ------------------ (Complete in Duplicate) <br /> --------------------- This Permit Expires 1 Year From Date Issued Date issued _J_-_ -------- <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--- ---------- ----�0- - - lir ---------------- ---------------------- <br /> A ` <br /> Owner's Name------------ r .!_a........ ,./���7 0 Phone <br /> Address----------- ------ .-.._ +� <br /> Contractor's Name------------- ' <br /> Installation will serve: Residence LN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: __ _____ Dumber of bedrooms __ _ <br /> f �_._ Number of baths ------ Lot size . 0 '_�__p -_-_____-___ <br /> Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table G - ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) NoF--1 New Construction: Yes ❑ No K- FHA/VA: Yes ❑ Nom' <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-_-L_? G�,e _ T' ______ <br /> No, of compartments______.-_Y----.-----Size---/ ' '_ ___Liquid depth___�5'���-----..Capacity_- __�..--- <br /> Disposal Field: Distance from nearest well..__�-f--Distance from foundation_/,__.Distance to nearest lot line___-�_---. Q , <br /> Number of lines_ - � ----------Length of each line________ � Width of french----- <br /> a _ -------------------------- <br /> Seepage <br /> ;0 V�T e of filter mat - Qe th of filter materialTotal length <br /> __________________ \ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- <br /> F-1 r Number of pits----------------------Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool; Distance from nearest weEi-------------_---Distance from foundation--- ------lining material------------------------------------- <br /> F-1 <br /> ___.___--- -__-____-.___❑ Size: Diameter---- ------ -------------- ----------Depth----------------------------------------------------Liquid Capacity-------------------- - ----gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line-------------------------------`-------------------------------------- --------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)-------------- -��---s ----- - -------�. r> ./. ----------------•------------•------------------- <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, a ules and regulations of tlSe ?)Joaquin Local Health District. <br /> (SignSi ned _ _ l �a sen, -- n and/or Contractor) <br /> ed) ----- - --- . ...1,511---- <br /> ----------------------------------------------------------------------(Title)---- : /........ <br /> (Plot plan, showing size of lot, locati of sysfetn in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY ,(� <br /> APPLICATION ACCEPTED BY - - -- ----------------------------------------------------------- DATE--------`orf " � ------- <br /> REVIEWEDBY-------------------------------- -------------------------- ---------------- -------------------------------- DATE------------------------- <br /> BUILDING PERMIT ISSUED-------------------------------- ---------------- ---------- -----------------------------------.- DATE-------------------------------- <br /> A terations and/or recommendations: ----------------•----------------------------------------•-•-----...------------------------------------------------ <br /> ---------------------- <br /> ---- - - <br /> ------------- - <br /> -------------- <br /> - ---- --- --- -- <br /> GG ��..P— ----- ----- <br /> ------------------------------------I------------ ----- --------- ----- a <br /> ----- ------ ---- ---- --------------- --------------------------------�-------------------------------------------------------------------------------------------------------------------------------------- ------------- <br /> FINAL INSPECTION BY:.------ --------------- ------ Gate - ---------------------------------- -; <br /> SAN JOAQUIN LOCAL '1EALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r <br />