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FOR OFFICE USE: <br /> ----- - ---------- ------------ ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. 6a 41-_._-6S. <br /> ------------- ------ -- -- ------ ----- Com lete•In Duplicate) <br /> ---------------- -------- ---------- --- -------------- <br /> -- This Permit ` P pt Expires 1 Year From I Date Issued Date Issued .__�f�-_��__ <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install file work herein desc bed. <br /> This application is made in compliance with Counf4Ordinance No. 549. A SC . 23 d.3 <br /> "Y�0 8 Y� /✓ /�w 5/ � �/. ' ./moi�""a�9"� /"'a . <br /> JOB ADDRESS AND LOCATION -------- ------------------------ •----- ---- /------------------------------------------------------------ <br /> ------------ <br /> -------------- <br /> Owner's Name - 6g� 7cj'[,S----X/g <br /> ✓�?w---------- ------------------------------- ----- Phone <br /> Address---------------- -------------------------------------------------------------------- ------------------------------------------1-1---------------------- •---- ---------- --- <br /> --r <br /> Contractor's Name___._-_p_�y__ V'_'QpyVy�� X66 - V__W7- <br /> - --- -- - Phone --- --- -- -- ------ ---- <br /> Installation will serve: Residence X Apartment House E] Commercial E] Trailer Court E] Motel ❑ L]Other <br /> Number of living units: __ .---- Number of bedrooms _---..__ Number of baths-------- Lot size _____ ___ _________________ --------------_______-_______._ <br /> Water Supply: Public system ❑ Community system E] Private X Depth to Water Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ `Gravel ❑ Sandy Loam ❑ Clay Loam 11 Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_------- ------ No ❑ New Construction: Yes Er No ❑ FHA/VA: Yes (� No ❑ I <br /> j `} <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from ne ----- 1I1 ._...__Dist [7tD from � ____________________M �i I -----------------------------------------� .4�No. of compartments----------- --- -- depth Capacity/C <br /> �. <br /> Disposal Field: Distance from nearest well---------I1--------Distance from foundation____________________Distance to nearest lot line________--------- <br /> ® <br /> Number of lines.-----------Y___ - -_�.--- - -_Length of each line_- ------ <br /> /.P---- --- Width of trench----.---- - --- ------ <br /> Type of filter material-__. .___Depth of filter material-----------------------Total length-------_'Y _�_-'F' <br /> -- -----------. <br /> Seepage Pit: Distance to nearest well-----....__.I1-.-------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> Number of pits.._ ------------------Lining maferial_G3_0_'".4.FSize: Diameter-----3....r__...___Depth.......y_`-'�___.--___________- <br /> Cesspool: Distance from nearest well _-____I1---------Distance from foundafiian----.........___ _.Lining material-------------------------------- -- <br /> [❑ Size: Diameter- - -------- ----- --- .........Dept h...... --------- -----------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest we11_ I1----------------_--------_-..._._____-Distance from nearest building....__.____._______._:___-____________-- <br /> ❑ Distance to nearest lot line - <br /> --------------------------------------------------------------------------------------- ------- ---------------• ---------------- - <br /> Remodeling and/or repairing (clescribe�___________________IM___ -- <br /> -----•--------------------- ------------------------------•------------------------- I�--------------------------------------------------------------------------------------------------------------------------------- --- <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 <br /> and regulations of the San Joaquin Local Health District. � R <br /> (Signed)---------- - -------------------------- -------------------rr. ----------------------._................-------- ---- ------------ --------(Owner and/or Contractor) <br /> By:-------------------------------- -----------------------------------!------------------- ----------------------------------- .....(Title).......... .----... . <br /> {Plot plan, showing size of lot, location of system ini[relation to wells, buildings, etc., can be placed on reverse side). <br /> ,i FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___.__ !f' <br /> U ------------------- ------- ------------------- DATE r <br /> REVIEWEDBY-------------------------- -- --- I------------- - --------- --------------- ------------------------- DATE----_-------------•------------- <br /> BUILDING PERMIT ISSUED-------- -- --- c IM QATE. <br /> Alterations and/or recommendations:- .. L/ - ------------------- ----------------- -------------------------------- ---------------- <br /> ----------------------------------- ----- - -----------= _... - ----- ---------------•--------------------------•--- -------------------------.. <br /> IM <br /> ------------------- ----------- ----------------------------------- - <br /> ­�.0' __ _---- - -- ---- --------- <br /> FINAL INSPECTION B .... '. - M-------- ---------- Date-------- 7_-_Z1 <br /> SAN JOA� QUIN LOCAL HEALTH DISTRICT <br /> 1l <br /> 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> I <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> 4 E.H.9 2M 1-67 Vanguard Press <br />