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- � �- <br /> FOR OFFICE'L15E: � � �— <br /> t <br /> -------------------- <br /> F � 1 <br /> - ----- --------------- ---..---.--.---__ ___ .-.__-.-- APPLICATION 4R SANITATION HERMIT Permit No. �-..... .-- -. . <br /> - ---- ---------------------------------- --- ---------- (Complete in Duplicate) <br /> -------------- This Permit Expires 1 Year From•Date Issued Date Issued -- --r--.- �� <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. 544. <br /> JOB ADDRESS AND LOCATION ------ - -----I r �/ <br /> Owner's Name-------------------------J. = �- ��s�1� -------------------------------------------------------------------- PhonefP---✓`�-7��.--. <br /> Address . e_ --------------------------------•------•-------------------------------••----------------•-------------.-.-.-.... <br /> Contractor's Name------- .t .P1s/ C1 Phone--- - �? F� � <br /> ---------- --- ------------------------------------------------ <br /> Installation will serve: Residence /Apartment House [] Commercial ❑ Trailer Court E] Motel E] Other [3 <br /> Number of living units: _/__'.Number of bedrooms --_/-- Number.of baths ----/- Lot size ---------- - ---7 -------------_------- <br /> Water Supply: Public system 9KCommunity system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand (] Gravel ❑ Sandy Loam ❑ Clay Loam ©!Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: llf yesldate__--._-------------I No O-Ne Construction: Yes ❑ No ©, FHA/VA: Yes ❑ No [�J— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool'permitted if public sewer is available'within 200 feet.) <br /> ,i <br /> Septic Tank: Distance fromnearest well-----------------Distance from foundation--------------------Material----------.--------------- <br /> .____.----.___--..___-. <br /> ❑ No. of compartments--------------.-:----------Size--------------------------------Liquid depth---- ---------------Capacity..--------------------- <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation---------:----------Distance to nearest lot line-------_------_ <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Widtk of trench--------------.-------------------- <br /> Type of filter material-------------------------Depth of filter material---------------_------Total length------------------------------------------ <br /> r.� <br /> Seepage Pit: Distance to nearest well------- ---- <br /> ---------Distance fr fon dation----.Z.Q--- ..Distance to nearest lot line-_. - --- 0q <br /> L Number of pits.r..l---------_....Lining material--. _ e 1E'..Size: Diameter------33........Depth.....�-5_ ----.------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....--.- .---.----.Lining material--------------------------------------- J:ii <br /> ❑ Size: Diameter- - --------------------------------- Depth--------------------- --------------- ------------Liquid Capacity--- ------------------------gals. <br /> ----------------Distance from nearest building.__:_.--------------------- <br /> Privy: Distance from nearest well------------------------------------------------- __--___--_-.-. <br /> 1 ❑ Distance to nearest lot line----------- --------- ---------- 3 <br /> s Remodeling and/or repairing (describe):------- <br /> -_ Y?.-__( <br /> I <br /> ..{ ----------------------- ------ <br /> I ------------------------------------ <br /> ------------------------------------------------- ------------------------------------------------------------------- ----•------------------------------------------------------------------ --------- <br /> ------------------------------ -----------------------A----------------------------- <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, a�nddres aii'd regulations of the San Joaquin Local Health District. <br /> t <br /> (Signed) ------------------ * � f =.------�' - ------------ --- . -.wrier nd/or Contractor) <br /> I BY g �. ,-- .��-------------------------- (Title) -------- <br /> (Plot plan, showing size of lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). <br /> r <br /> # ( FOR DEPARTMENT USE ONLY <br /> APPL1CATlON ACCEPTED BY- --- -- -�r��-....---`- - - � �=--�----=----------------------- DATE------4�f� 6.a <br /> - - -- --------------------------------- <br /> REVIEWED BY = ..... <br /> ----------------------------------------------------------------- DATE---------- <br /> BUILDING <br /> - •---BUILDING PERMIT ISSUED-------------------------------------- --------------- DATE <br /> Alterations and/or recommendations:____ �5 /6� :--.-._6x--- <br /> ---------------------------------- <br /> ----------------------- --------------------------------------------------------------- ---- ---------------------------------------------------------------------------------------------- ------------------------ --- <br /> k -� <br /> / f <br /> i- Date------ <br /> FINAL INSPECTION BY: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haseiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />