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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />--------------------------------------------------------- <br /> (Complete in Duplicate) <br /> Date Issued ____ ... _____ <br /> --- --------------- This permit Expires 1 Year From Date Issued t <br /> t <br /> Applicafion 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. 1 <br /> �� •. ------ - z -- �..�-,�-------- <br /> JOB ADDRESS AN LOCATION °� _ _._ t._____-. : .. <br /> ,. <br /> Owner's Name `- fiJ�u(, --- <br /> ------------------------------------------------------ <br /> - ---------------------------- ----------------------------------- Phone , <br /> f� r- <br /> Address h.� lr ----------------------------------------•----------==-- -- •-•---•------------ <br /> Contractor's Name; '-� , yL� =1 - - (r���f f <br /> -------------- Phone ��' <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial [] Trailleer'Court ❑ Motel ❑ Other a-v" <br /> Number of living units: -------- Number of bedrooms -------- Number of baths-`" Lof size ___ _'�_ _ -- - - ------------ <br /> Water Supply: Public system ' Community system ❑ Private ` Depth to Water Table yoft. <br /> Character of soil to a depth of 3 feet: Sand E]i: Gravel ❑ fSandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' Hardpan ❑ <br /> Previous Application Made: (It yes,date---.----- },, No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` ' � � ' '' -.4 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , O <br /> Dis € # � .___.tDistance from flundationi---/ _ �--Septic Tank: l ° Material- = I <br /> F <br /> No. of compartments___a ________________Sized ` tom-�Liquid depth-.--.-�/__-_-____-____CapacitY__ ea7 <br /> Disposal Field: Distance from„nearest well..5-------------Distance from foundation__,-P--------.D,istance to nearest lot line 'a <br /> Number of lines__'.- - __� Lerigth'of°each line_ -f-- u '__--Width of french----------- ______________ r <br /> t - ! s Q- ------------ <br /> Type of filter matenal_ _!_ -:> Depth of filter matenal. w_`____..__Total length_____,l_u_ <br /> Seepage Pit: Distance to nearest well-/0Q-__-------Distancem f undation__- _ .------Distance to nearest lot line------ ---------•. <br /> Size: Diameter------� Depth---------` :K------------- <br /> ti <br /> Number of pits----#�--------=--Lining material---,- ------------ <br /> Cesspool: Distance from nearest well_ ______________Distance from founclation._.._.:____I_.Lining material---------.--------------._------------ <br /> Size: <br /> ____---_-.Size: Diameter---A----=------ - - -' '--------- Depth----- ------------------------------------� i--Liquid Capacity--------------- --------gals. <br /> Privy: Distance from nearest well------------------------ ...----------------------Distance from nearest building ____-----__---.__-..------_.--- a <br /> Distance to nearest lot line -' ---------------{---- - - ----- ------------------=------ -- -= ---------------------------------------------- --- <br /> be): ------------------ <br /> i Fi !- =---------------------------=--------------------------- --- <br /> Remodeling and/or repairing Idescri <br /> a _ <br /> ------------------------------------------j------­------------ -----------i----------------------------------------------------------------- -------------------------------------------- ---- - <br /> i n <br /> ' fI R <br /> -- -- <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, St to laws, and rules a cI 'regulations`of the San Jpaquin Local Health District." <br /> (Signed)________ <br /> -------- P `�� = L��'----��_------- ----------- (Owner and/or Contractor) <br /> Y` Y Title <br /> -------------- _ ( � ) <br /> (Plot plan, showing size of lot, location of system'in rel on to wells, buildings, etc., can be placed o reverse side). <br /> r <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- ___.__ <br /> ------------------------------ DATE------"ISjs ----------------------- ' <br /> REVIEWEDBY--------------------------------------- --- ----------------------------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED---------------' -- = --- ---- ---- -------------------------------------- DATE-------------- ------------------------------- ' t <br /> �, <br /> AI#erations and/or recommendations:`._��� ----------- - ----�---..��.. -��'-----------------•-------------•-- -------------------------------------- <br /> --------------------- <br /> --------------------- - --- j <br /> f ""-'----------LL-------'------------------------------- <br /> ------------------------------------------------------------------------------------ <br /> .-.....__.•------------------------------:-_...-_--.-..-.._-_-.....-._-___....------.-.--___.-...---------------.-----.--_----------1�-----------------•----""..._____-------------....-___-._..-_------.------------------------- <br /> .' ----------------------•-"'----------------------...._------"..-.__..__- ------- <br /> FINAL INSPECTION By.. -- ------ ------ ------ Date----- ----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT r <br /> 1401 E.Haxalton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street I <br />` Stockton,California Lodi,California Manteca,California Tracy,California I <br /> F.P.CQ- ,. 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