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FOR OFFICE USE:
<br /> APPLICATION FOR SANITATION PERMIT Permit No.
<br /> .. . ....... .. . ........ . ...:.. ��
<br /> (Complete,in Duplicate)
<br /> This Permit Expires 1 Year From Date Issued ,Dote Issued ..... ? .a.'.�.�
<br /> Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and insta!I the work herein described.
<br /> This application is made in compliance with County Ordinance N '. 549.
<br /> JOB ADDRESS AND LOCATIO�N ..t,?/I . (t . ...f.l.' . . .......... 1.'? ... .... . .... ...
<br /> Owner's Name . . .... Q.. fi.� .... ..... . ..... Phone..... .. . .... ...................
<br /> Address.......0 �/ . ... .e ..� -�~..... ....... . j...Ar�EiL�f" ... ..I. ......... ....................
<br /> Contractor's Name.... . ... * - ./�Fr('L �r �. ... ...... ..... . . .... . ..... .. . . Phone...... ............................
<br /> Installation will serve: Residence &-AXpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑
<br /> Number of living units: .. Number of bedrooms .? Number of baths+9. . Lot size .......j�- .... . .. ......... ....
<br /> Water Supply: Public system ❑ Community system ❑ Private �'5epth to Water Table40 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.. ... ... 1 No &� New Construction: Yes A--No ❑ FHA,'VA: Yes 4+-- No ❑
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:
<br /> (No septic tank or cesspool permitted if publics sewer is available within 200 feet.)
<br /> Se tic >Pk: Distance from nearest well %5—Q . .Distance from founda 'on... ... ....
<br /> No. of compartments Size.'y ._...�..I?C.. ..Liquid deptn.��r . ... .. ... Capacity./ZAP.....
<br /> O ' '
<br /> D;sposal F e,d: D'stance from Weare we �� . ..D stance from fcunde'ion. ...o
<br /> L�- ... .Distance to nearest lot line�a�.......
<br /> Number of lines ength of each iine.,�APe. X Width of trench Z.�.�..... ... .....
<br /> Type of f Iter materir3y/� j� .. . epth of ;iltcr material �� . . . dotal length �np..
<br /> .. .....................
<br /> \ �
<br /> IN
<br /> Seepage Pit: D�stance to nearest we,'•.,0/-r0 Distance fr n fo cat-or. �A07. . Dist to nearest '.ot lin.� .....
<br /> 0000, Nurnber of pits... �� _ .. ..._...L:n:-.g material Aj� z+ : D;ame er Depth��. .... .... .......
<br /> Cesspool: D:starce f.om nearest wel! ..... ..Distance from fou-datic-,. . . . . Lining material.. . . . ... . .... ............
<br /> ❑ Sire: D:a,reter. .. ... . ..... .. Dept. .. .. Liciuio Capacity. . . .. ... . .. ....gals.
<br /> Privy: Distance from nearest well............ .. .,.,., .. .,., .Dista-ice from nearest ou'(dinc...., ...... ...............,.,..... .,.
<br /> 1] Distance to nearest lot line . . ........ . . .
<br /> Remodeling anc/or reoairino ydcscriL�e; ErL'f/ / . . .....
<br /> ................................................ ......... ................... . .. .. . .. ........ .... ....... .... ......... . ............................... .
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<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, and rules nd regulations of the San Joaquin Local Health District.
<br />«� (Signed).......... .... .... .. (GMS or-ContractorJ
<br /> _ By:....... ...................... . .... ........ . ........ .
<br /> (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side).
<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY.... 4
<br /> REVIEWED BY. .... . ......... . .... . ... DATE. .. .
<br /> BUILDING PERMIT ISSUED ...... .. .. ... . ...... DATE. .. .......... .... ... .. .. . .. .......... .. _
<br /> Alterations and/or recommendations:..... .. ... . . ........ . . . . ...... ................. .... ...... .. .. .
<br /> . .................... ..,......,.....,........,.. . .....,.. ... ..... ............. .... .
<br /> ........ . ..... ......... ......,......,.,., .... ..,., ..........,.,. . . .. . ........,..........,. . . ....... . ..... ... . .. ....
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<br /> FINAL INSPECTION BY:,.� ... . . ., Date.-/�.r�, ,., r
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 1001 !.Moselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street
<br /> Stockton,California Lodi California Manteca,Colifornio Tracy, California
<br /> E.H 9 2M 1.67 Vnnq.ord Pr/s{
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