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FOR OFFICE USE: " <br /> --------------------------------------------- -- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._l.y . <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 /> d <br /> JOB ADDRESS AND OCATI <br /> --j------ .__ ifY <br /> /..-------bg fC 7------._._. Phone---------------------------- -------- <br /> Owners Name.__.___ <br /> Address----------------- --- -- --- --- --- --- -� <br /> -----------•------•------------•-•-----•-•-----------------------•- <br /> r <br /> Contractor's Name------- = - *J2x—S--�-------� �--r--c--+-----------------------------------------------•--------- Phone_ [ _&_677. <br /> installation will serve: Residence ❑ !Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other A S'(1.,,eel <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size _-_------------------------- <br /> Water Supply: Public system ❑ Co mmunity system ❑ Private Z Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Z Gravel E] Sandy Loam ElClay Loam E3Clay ❑ Adobe E] Hardpan ❑ <br /> I <br /> Previous Application Made: (If yes,date____________________) No ❑ New;Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0 <br /> Septic Tank: Distance from nearest well------ ----------Distance from foundation_____________ ___.Material------------------------------------------------ <br /> E] <br /> ___._._________ ___ __..._____..____...._____❑ fo5+14Z No. of compartments--------------------------Size--------------------------------Liquid dep`h-----------------------..Capacity---------------------- <br /> Disposal Field: Distance from nearest well_ 0 _.__.Distance from foundation_. W-------Distance to nearest ylot rr e_/------ <br /> Number of lines__-¢_______ ________ --Length of each line___.��.__ __ _ Width of trench.___.?-�P_______________________ <br /> fTyr--- - � N <br /> Type of filter material --Depth of filter material-___f_�________-__Total length-----Z®_Q_ _---------------_-._ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--_-_._._____.___ <br /> ❑ Number of pits-----`----------------Lining material---------------........Size. Diameter---.-------------------Depfn---.------.--------_------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....---------------.Lining material----.--------_.___.______________..__. <br /> ❑ Size: Diameter------t------------- ---------------- Depth--------------------------------- -----------------Liquid Capacity ----------------------gals. <br /> l <br /> Privy: Distance from nearest well_-- ------ --------------------------------------Disfance from nearest building---------------- -------------------- <br /> ❑ Distance to nearest lot line--------- -----------------------------------------------------------------------------------------------------------­ ------------ <br /> �e o17 <br /> Remodeling and/ repairin escriiI`'' S- E _- _ <br /> -*i <br /> ------------------------------- -- -- <br /> - - -------- <br /> I <br /> ! hereby certify tave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State I ws, and ru s(Qand[r[regulations of the San Joaquin Local Health District. <br /> (Signed) ' `V ------------------------------•------------------(Owner and/or Contractor] <br /> r <br /> By-----------.�;-:----:ti '1 ----- s �- - (Title) <br /> (Plot plan, showing size of lot, location of system in relation Fo wells; 6i�ildings etcc�ri`be-place n-reverse-side].,::.. <br /> FOR DEPARTMENT USE ONLY I <br /> APPLICATION ACCEPTED BY------------------------------------------------------- --- -------J, - _91 L DATE--------l-r--9-- ---r---------------------------. <br /> REVIEWEDBY------------------ -------------------------------- ---------------------------- -- -- ---- ------------- ----------------- DATE-----------------------•----- ------ ----------------------- <br /> BUILDINGPERMIT ISSUED-----•-----------!---------------------------------------------------------------------------------- DATE----------------------------------------------------------- <br /> Alterationsand/or recommendations-.-I.... ------------------------------------------------------------------------------------------------------------ -----------•------------------------------- <br /> ------------------------------- ----- ---------------------------- - ----- -------------------------------------------------------------------•---------------- -------- --------------------------------------------- <br /> ----- ------------------------------- ----------------- ---------------- -------------•--------------------------------------------------------- ----------------•-----------------------:----------------------- <br /> ------------••--------------- ---------•------ ------------------------ ---------------------------------------------------------------------- ----------------------------- -------------------------- <br /> - --------- ---- --------------------------- ------ --------------- <br /> , <br /> FINAL INSP CTION B . Date -------- s �' ---------------------- I <br /> SAN JOAQUIN LOCAL°HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> d <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.0 O. .Fa fi <br />