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FOR OFFICE USE: <br /> -------- <br /> APPLICATION F(5R SANITATION PERMIT Permit No. <br /> --------------- .! <br /> -------------- --------------------------------------- (Complete in Duplicate) <br /> Date Issued ..____�-•�'-__.� <br /> --------------___..__._-.-.---_.__..___._...__.__-._-._ This permit Expires 1 Year From 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 LOCATIO ------/_1� ----------•----------- ----------------------------------- •----------------------------------------------------------------------- <br /> • -------------- Phone__4�e 5— 9-1/D <br /> Owner's Name--- -- - ------ ----------- <br /> 14 <br /> Address ... ----•-------- --------- ----------.... ---- ------------------------------------------------- ­----------------------------...---- <br /> Contractor's Name__ # <br /> - -- - ---- ----- ------... f - Phone..�7�ldl�'-3f�Z <br /> Installation will serve: Residence Q-"Apartment House ❑ Commercial ❑ Trailer Court ❑ //Motel ❑ Other <br /> _ ❑ <br /> Number of living units: /Number of bedrooms _3_._ Number of baths -1--__ Lot size ____�8 -----124__.--________________ <br /> Water Supply: Public system P?__Community system ❑ Private ❑ Depth to Water TaHe;s_-Oft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No ❑ 4 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: fi <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ter.- <br /> c T Distance from nearest well-----------------Distance fromffoundation_____--..._._____._.Material____._.__.___.__-.----------I-------_--------- <br /> No. of compartments-- --- -------- ----------Size------------------: 'Liquid depth---------------- ----- ---Capacity-_------------------- <br /> Id: Distance froml'nearest well.................Distance from foundation__________---_.-__.Distance to nearest lot line----------------- <br /> ❑ Number of lines-----------------------------------Length of each line---------------------_-------Width of trench------------------------------------ <br /> rnrnU� Type of filter m <br /> aterial--___--_________________Depth of filter material-__.._._.------ <br /> -----------------------Total length__________________.____.-_-_-___-_ <br /> ____. __._ <br /> I _ � <br /> Seepage Distance to nearest well� Distance f m foundation___. v____.Distan -----------___ <br /> Number of pits.---�--------------Lining material_�/_C1�.--...Size: Diameter----3-'3-----------Depth----.-. �.--S--I_----------- <br /> Cesspool: material <br /> r� <br /> Distance from nearest well_________________Distance from foundation----______._._..-.-.Lining material__.._________--_---___________-______- J <br /> ❑ Size: Diameter-----------------------------------.-Depth----- ----------------------------------------------Liquid Capacity_-------------------------gals. <br /> Privy: Distance from nearest well .............. ________._-.-___---_._...Distance from nearest building-----.-------------------------------..._.z, <br /> ❑ Distance to nearest lot line-----,--------------------------------------�Z-------------------------- ---------------------------------- ------------------------ <br /> Remodelingand/or repairing (describe):------------ ---------------------------------=-----------------------------------I------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------=-----------------------------=----------------- - ------------- ------------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------•--------------- <br /> ; -- <br /> ---------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- --- <br /> d <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, a laws„and rul s an regulations of a San Joaquin Local Health District. <br /> (Signed)----- ------------- ---- ------ - ----------- ----- ---------- P <br /> --------------------------- ------------------- ----..Owner and/or Contractor) <br /> Title <br /> (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). <br /> A <br /> FOR DEPARTMENT USE ONLY <br /> ot 04 <br /> APPLICATION ACCEPTED BY-------- -------------- ---- ---------------------------------------- DATE------ -- <br /> ' -� <br /> REVIEWEDBY--------------------------------------------------- --------------------------------- ---------------------------------------- DATE---------- ------------------------------------ <br /> BUILDING PERMIT ISSUED---------------------------------------- - ATE---------- --------------- -------------------------- -- <br /> Alterations and/or recommendations:--- --------��. ./6�. ------ --------•-------------------------------------------------------- <br /> FINALINSPECTION BY:................. .._ ,:.--------------- Date-------- ------- -- -------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. - 1 300 West Oak Street � � � .124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P,CO. <br />