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4 FOR OFFICE USE: <br /> -------------------- ---------------- <br /> _..................... ...... -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 9..�a2Z_3 <br /> ----------- t--- <br /> This permit Expires I Year From Date Issued Date Issued <br /> (Complete-;n Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein iescrbed. <br /> This application-is made:in'rcompliance,with County Ordinance No. 549. <br /> A- tG-KE, «F1i E <br /> JOB A'DDRESS A D-LOCATION .;---2 v_ = ? - <br /> ,c 4 <br /> Owners Name--- -- - - - - - ----- -• •----- -.:-� -- <br /> = rS-�•`�. ---- --- ----- - _-------------------_-'- <br /> Phone----------------------••------•--- <br /> Address-- ------ <br /> ----------- <br /> ---- -- ... <br />;i Contractor's Name_.-__.__ J------- <br /> ------ <br /> : ....... <br /> -- -------------------- Phone..----.--------------------------- <br /> Installation will servei Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._ Number of bedrooms _`"°'__ Number of baths-T_ Lot size __._. -__ ------------------------------------------------- <br /> Water <br /> ______________________________Water Supply: Public system ❑ Community system ❑ Private 2f---D'epth to Water Table -__--_ _ ft <br /> Character of soil to:a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [Adobe ❑ Hardpan a ' <br /> i 1 i <br /> Previous Application Made: (if yes,date------------- ----- ] No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> -(N6 septic tank or cesspool permitted if public sewer-is-available within 200 feet.) <br /> / ------------------------ <br /> Septic nk: Distance from nearest well---is�'Q-.__Distance from foundation------L_.�-------Matenal -------_ t <br /> No. of compartments-----...;+- - -- .__ Liquid dep`h- --- ;----- -- Capacity...___. Q_ <br /> i ! <br /> Disposal Field: Distance from nearest well-�o �%?.._...Distance from foundation---._d.D._._----Distance to nearest lot line------------------ <br /> Number of lines_F___._._._ <br /> I---------------------Length of each line-- -----J-.v1?---------..Width of tranch..--:AT-------------------------- <br /> Type <br /> ----------- - ----- <br /> Type of filter material_____--S_ Iii..,----Depth of filter material.........1.9. ......Total length-------- f_a __° <br /> I a <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----_-.__..___.._ <br /> ❑ Number of pits--- -----------_---Lining material-----_--_---_------- Size: Diameter-.---------------------Depth_..------------------------------ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material-_-_....--_----_-- __.____..___ r <br /> ❑ Size: Diameter- -- -- - ----- - - ----------------Depth-------------------------- ---- . - - - ---_..Liquid Capacity-- ------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-__._-._____.-..--------____..__..------- 1T <br /> ❑ Distance to nearest lot line ----------- ---------- ---- ---- --------------------•-•------------ <br /> Remodeling and/or repairing (describe):-------- ----- --- - --------------- ----------------------------------------------------- -- - --------------------- •----------------- <br /> ----=------------- #------- ------- -------------_--------- ----- <br /> ------------------------------------- <br /> ----- <br /> --- C <br /> _ --------- <br /> _ _ _ _ _________________________________________________________________________________________________________________________________________ Pl <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, d rules and regulations of the San Joaquin Local Health District. <br /> (Signed) - - --------------------------- --- ------ and/or Contractor) , <br /> - •y <br /> Y� } ------- --------- <br /> (Plot <br /> - ---- - (Title) ----- ------------ ------ . -. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__... . .........._. __ __ ._ / <br /> -- - - -- -- -------------------- -------- - ----------- -------------- DATE__ <br /> REVIEW!=D BY------------------------ -------•- - - - - -- -------------------------------- -------------- ----------------------- DATE----------------------------------- <br /> •----------------------- <br /> BUILDINGPERMIT ISSUED-------- - --- I �------------------------------------------------------- -- --------------------._ DATE--------- -------------------- -------------------------------- <br /> Alterations and/or recommendations----------- ........... -------- --------- - ------------------------------------------- ------ <br /> ­­-------­­_------------------ <br /> ------------------------------------- ------------------------------------ -------------------------------------------------------------- ------------------------•---------- -- ------------------------------------=-------- <br /> ------ ------- ---- -------•---------------------------------- -..---------------- ••-------- --------- <br /> ----------------- ------------------------------------- ------ -------------------------------------- --- <br /> ----- -------------------- <br /> -------------------------- ------- -------- -.------ ---- ------------------------------------ ------ - - ----------------------------- <br /> FINAL INSPECTION BY:.. . _- -- - -•---------------- Date---. ... .�61 <br /> F' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California <br /> Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press r <br />