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LFO OFFICE 5}: <br /> . %-z '._- APPLICATION FnR SANITATION PERMIT <br /> Permit No. . l_.7.I....----.`- <br />------------------------------------------------------- (Complete in Duplicate) Date issued .. !�.......'Y.. <br /> "_ I This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healih District for a permit to construct and install the work herein described. <br /> This application is made in compliance with"County.,Ordli ante No. 549. <br /> JOB ADDRESS AND LOCATION .] -•-•-- .......•-------------------------------•---•--•-------- -------.....-----------........ <br /> ------------- - <br /> Owner s Name------- -------------- ------�--)44--- -- ------------- ----------•-------------•------- <br /> ;1-------------- Phone-------------------------•--------- <br /> �.e <br /> % --------- <br /> Address-........ _ _ ,... .............................................. <br /> l ' --•---••-•---•-- Phone <br /> ----------- <br /> Contractor's Name__-_____.... <br /> ''� 3 1 <br /> Installation will] serve: Residence EZ/ Apar meat House ❑ Commercial,[] Trailer Court ❑ Motel ❑ Other ❑ <br /> ~ - -------••-......---•-•-------------•-•- <br /> Number of living units: __°,�,., Number of bedrooms __�_ Number of baths __�-_ Lot sae ------- . <br /> --F - . <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table �_ ft. <br /> Character of soil to a depth of 3 feet:! Sand Gravel Sand Loam Clar Loam Clay Adobe Hardpan <br /> ❑ ❑ Y ❑ Y. ❑ y ❑ u„ ❑ <br /> No <br /> Previous Application Made: (if yes,date"__"-__"-----------) No �N <br /> New Construction- Yes o ❑ FHANA: Yes [I <br /> �r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool perrnifted if public sewer is available within 200 feet.) <br /> Septic Ta Distance from nearest well-----------------Distance from foundation--------------------Material_____-..___-___"______---------------.---_------ <br /> �j� No. of compartments-------------------------"Size---------------•--------•-------Liquid depth------------- Capacity <br /> posa! Feld: Distance from nearest well-______________"_Distance from foundation__.._._.__-...______ <br /> Distance to nearest lot line..........___.___ <br /> DisNumber of lines--A--•.-•-------------- <br /> Length of each line. ------------------...Width of trench--------•-------------------••�T. <br /> Type ofYfilter material-------------------------Depth of filter material--------•--------------Total length-_.-..,----------------_---- <br /> T_ <br /> ---------------------•-_-•f 4_� , <br /> Seepage Pit: Distance to nearest --- from foundation----lj?_..........Distance to nearest.IotJiwe___-------------- <br /> Number ----------Depth, <br /> of pits_..;_I__'_------------Lining material---�'�-?-�-----Size. Diameter__�:�_.._ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---_---------------_Lining material____'_____._______.__"_____--.._.__. <br /> ❑ t Size: Diameter ----•-Depth------- = -------------------Liquid Capacity_------------------ <br /> Privy: <br /> gals. <br /> i l "_Distance from nearest building Privy: Distance from nearest well------ 9 ; <br /> "'Distance to nearest lot line ' <br /> ii Z <br /> Rem deling end/ora repairing (describie):____--."_---_____-_ - `�' <br /> ----•------ <br /> -------•----------------------------------- ------••-•--------------- <br /> ----------------- I <br /> '' '-* -'t ---------- --------------------------------•-----------------•---- <br /> I hereby certify that I hiave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws;and`Wes and regulations of the San Joaquin Local Health District. <br /> {Ownerad/or Contrectorl <br /> (Signed -- <br /> BY: ; <br /> {Plot plan, showing stz of lot, location of system in relation to wells, buildings,;etc., can be placed on reverse side}. l� <br /> k l i FOR DEPARTMENT USE ONLY <br /> F s---- DATE..-` 7-----6-�---=---•-------- <br /> APPLICATION(ACCEPTED BY...._�,�.�,�i�<---�------------ <br /> REVIEWEDi3Y_-.. .. ---------------- DATE =-- -_----------------....... ------------ <br /> BUILDING PERMIT ISSUED l i ATG <br /> Alterations and/or recommendations:�a°-_ ----- - 1" <br /> X_ <br /> ....---�-------------------------------------------•--------------•---•-------------••------ <br /> ! ----••-- <br /> ----------- <br /> ---------------------­­--------------.. . <br /> FINAL INSPECTION BY: Date--- �- 65%_____----------------------------- <br /> 4 SAN JOAQUIN LOCAL HEALTH DISTRI <br /> r 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E6 9 REVISED S-S9 2M 3-61 AILAS - <br />