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FOR OFFICE USE: <br /> 8"--------- - ------- " <br /> -- -------------------------- -------- - <br /> APPLICATION FOR -'SANITATION PERMIT Permit No. . <br /> ------- ------------- ------ -- -------------- ------ - (Complete-in Duplicate) <br /> __ __.._.. This Permit Expires 1 Year From Date Issued Date Issued __' 9 �_ - <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 OCATION------1!_D,5 �..__ /�% ac ' -------------------------------------�------------------------- <br /> Owner's Nam --------- Q_/�[J._-.__--C-271 <br /> a,�----•--------------------- - ------ ----- -- ------------------- -- ----------- Phone-_./7 <br /> // 7 -4• . <br /> Address ) - --------------- ---- - ----------- ----- -------------------------------------•---- ---------------------------------------•--- <br /> toContracr's Name- of •-------- ------ Phone-__.,, -------------------- <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ -.- Number of bedrooms _v:._ Number of baths-1.- Lot size ._ d_ -�- - - - ----------------------- <br /> Water Supply: Public system ❑ Community system ❑ Frivatefid Depth to Water Table -/_22_ ft \ <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,®' Hardpan ❑ <br /> Previous Application Made: (If yes,date_P?1k-cZ- ] No ❑ New Construction: Yes ❑ No ®' FHA/VA: Yes ❑ No ❑ O <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 /> ❑py,4 j No. of compartments---------------------- ---Size-------------------- -----------Liquid depth--------- ------- ------- Capacity----------------------- <br /> Disposal Field: Distance from nearest well_Sa- Distance from foundation---/P- -------Distance to nearest lot line�5__--..__-.__ <br /> xf Number of lines__.___I__._ _______Length of each line__ --_7r7------------------Width of trench._--_..�%-______---__-.-__ <br /> -----/ ----- <br /> Type of facer material <br /> ___> -1. -4 --� ----Depth of filter material----A�f__--------Total length-----------------------5__________---_. <br /> Seepage Pit: Distance to nearest well..........................Distance from foundation--------_-----------Distance to nearest lot line-----..-.--.___.- <br /> ❑ 0,�,„;,j Number of pits--- ------------------Lining material--------.-- Size: Diameter-----------------------Depth------------------------._.----._ <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 /> Remodelingand/or repairing (describe):------------------------------------- -------------------------------------------------------•-------- ------------------------------------------------ <br /> --------------- <br /> -----------•---------- ----------------------- <br /> ------------------------------------- ------------------------------------•---------------------------------------------••-•-------------------------------------------- ---------------------------------------------- -- <br /> ----------------------------------------------------------- -------------------------------------------------------------------- ----- - - <br /> I hereby certify f9at 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)----- .- ----------------------•--------------- ----6Rrl- <br /> 2E!�� <br /> ......( wner and/or Contractor) <br /> {Title) -�' 'BY: ---------- -- -------- <br /> (Plot plan, showing size of lot, loclls, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___ v n <br /> - ------ - --- ---- ----------------- ------------------------- --- ---------- DATE.- -v�---R"'-�'- - ------- -- <br /> REVIEWEDBY----------------------------------- ------------------ ------------------------ -------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED---------- -------------------- ------- ----- - DATE --------------------------------------- <br /> Alteratio�a and or recommendations ___ .�.13- -�... �'�c.�r..- ---- --•-�---- "--- --- <br /> /� <br /> �­Oo�� <br /> - ----- ---- a <br /> kG! ��-t>- -. ---------------------- -- -­--- --- -------- ---- - -------- ------ - ---- - ------ ------------- <br /> FINAL INSPECTION BY: --._.11 �. ------------------ Date s -.� _ �? <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon 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 />