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FOR OFFICE USE: <br /> rr <br /> ------------ <br /> -------- APPLICATION FOR SANITATION PERMIT Permit No. ._..f <br /> ------- ------------------- -------- -- ------- ------- (Complete in Duplicate) <br /> ..1...3 .b <br /> ______________ This Permit Expires 1 Year From Date Issued 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 /> JOBADDRESS AND LOCATION- !_. /G---------------------------•---•---------------•-------------------- •-------------------------------------- <br /> Owner's Name---- .... oti------------------------------•------• ----- ---- • ------------._ Phone....................-------------•- <br /> p <br /> --------------------------•--•---------------------••----•-•---------•-•--••-•---•-- - ------------- <br /> Contractor's Name------------------------------------------------- ......--------------------------------------------------------------•------ Phone..........................-•------- <br /> 'Installation will serve: Residence ❑ Apartment ;House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___1___ Number of bedrooms --,?—Number of baths v2.._. Lot size _1J_._x_.L •--_-._•____________________.__-- <br /> Water Supply: Public system E�K Community system ❑ Rrivate 0—Depth to Water Table 4� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ (Gravel ] Sandy Loam ❑ Clay Loam [j Clay ❑ Adobe FJ` Hardpan <br /> Previous Application Made: {1f yes,date---_----��___.I No L] New Construction. Yes F] No ❑ FHA/VA: Yes -] No ❑ <br /> .� ..` �. + <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer Wavailable within 200 feet.) <br /> Septic, Tank:. Distance from nearest well_______!--------Distaonce from foundation--------------------Material-----------------------------.------------------- <br /> e � No. of compartments------------------i-------Siz------I----------------------_Liuid de th____.___________________--Ca acit I <br /> Disposal Field: Distance from nearestell-/A¢-/�------Distance from foundation._/______._.__Distance to nearest lot line..:c�_~-.____. <br /> Number of lines---------- ____._._____ _ Lang4 of each line------A.-57')...............Width of trench-------- F__________.___ <br /> Type of filter material:_ hi ' '_t_____Dep h of filter material.._l, _('__________Total length_____cS�_---_________________________ <br /> Seepage Pit: Distance to nearest well--------------"------Distance from foundation--------------------Distance to nearest lot line----.-_-____._-_. <br /> ❑ Number of pits----------------------Lining mdforial-----------------------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 near.est.well- .-_#_V_-----------------------------------------Distance.from;nearest building_-___..._______________._.____-__---_____. <br /> ❑ Distance to nearest lot Mine*_e- )----------------------------------------------------­-----------I------ ----------------------------------------- <br /> Remodeling <br /> -------------------------•-- --------Remodeling and/or repairing (describe):------------ ---------------------------------------------------------------------- <br /> -------------------------------------------------- �.. I <br /> l <br /> • ............-------------------------------------------------------------------------------------------------- t <br /> I hereby certify that I have prepared this application and that the work willtbe done in accordance with San Joaquin County <br /> ordinances, State laws, and a les and regulations of the San Joaquin Local-cHealth•District. <br /> € <br /> M - 1104 '-A <br /> (Signed)-------------• --------------- - -- - ---- ------ -------------------- ------------------�------------------- -- -- - ---- -- • •-------------- -(Owner and/or Contractor) <br /> ---- --------- rifle <br /> Plot plan, showing size of lot, location of system in reg-- --- - • ---._.. .---•--------------------------{ )----------------------------- ----------------�-- ---------- <br /> •------------ -- --- <br /> ( p g y lation to wells, buildings, efc., can be placed on reverse side). <br /> — "­"'FOR�DEPARTME USE•ONLY�....r. _ <br /> -- ----------------------------•-•----------- DATE-- `'� ----------------- <br /> REVIEWEDBY--ACCEPTED BY------ - --��--- - - ---------- -----------------•-------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------•--------------------------------I----------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations---------------------------------------------- --------•--••-•----------•---•-----------------------•----------•--------------------•-------•-----••--------•---- -.. <br /> -•------•-------------------•--------------------------------------• ------------------------------------ _.._..__.-•-----.....---------------------------------------------------------------------------------- I <br /> ------------------------------------------------------------------------------------------------•--------------•-•--------_.-------------•------•---------------------------•----------------•------------------•------------ <br /> _.. <br /> ---------------------------------------------•---•----------------•-------------------•------- ---•--•----• -...-.---------------------.-----•--- <br /> FINAL INSPECTION B ------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 134 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca',California Tracy,California <br /> es-9 ReviSro e•sg r.r.eo.zM s-so <br />