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FOR OFFICE,- E: <br />-------------------- - <br /> APPLICATION FOR SANITATION PERMIT Permit.No. ....... <br /> ----------------- ---- ---- . ......... - ------------- <br /> -in Duplicate) <br /> -------------------------- ------- ----------------­- (Complete <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 /> JOB ADDRESS AND LOCATION--1/&�-0 1 .9 - 'S I., <br /> ----------- --------- ----------------------------------------------- <br /> ------------------------- ------------- <br /> ---ez"Ir <br /> Owner's Name -------------------------------------------------------------------------------- ---------------- ---- Phone-op <br /> Z --------------------------*-------------------------if-------------------------------- <br /> Address.... .caj­:*:�-n ----- <br /> Contractor's ----------------------------------------- <br /> Contractor's Name-/. ------ Phone---------------------------------- <br /> k <br /> Installation will serve: Residence.& Apartment House El- Commercial El Trailer Court El Motel El Other 11 <br /> Number of living units: -- ----- Number of bedrooms -3.- Number of baths __/... Lot size __34,47------ ----------- ------------ <br /> Wafer Supply: Public system Dd Community system E) Private F­l Depth to Wafer Table ft <br /> Character of soil to a depth of 3 fee+- Sand E-] Gravel 0 Sandy Loam E] Clay Loam [I Clay Dfl Adobe C] Hardpan E] <br /> Previous App.lication Made: (If yes,date-----------7------ No 5 New Construction: Yes L) No X FHA/VA: Yes E] No K <br /> 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t �� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--_....... .....Distance from foundation--------- --------Material ----------------------------------:---- ---- --- <br /> D No. of compartments--------------------- ----!Si z e------- <br /> -------------- -----------Liquid depth--------- ------- ----­ Capacify----------------------- <br /> Disposal Field: Distance fr& 'ne'arest well...... -."Distahce from 'founclation.-Il_..._._._._.Distance- to nearest lot line----IS------- <br /> Number of lines.-_.---------- .......------------------Length of each line---------- Width of trench_._- ------------------- <br /> Type of filter maferial__;�904F­k-------Depth of filterlmaferial----116............Total length.._.... ----------------- <br /> ' <br /> Seepage Pit: Distance to nearest well- _--t----- ---------Distance fr m foundafic,_1A-------Distance.Jo nearest lot line--.-,'O 77----- <br /> T <br /> Number of pits--- I----------------Lining material....... Size: ..............Depth...I-1r, "�----------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation.-.- ----- - .... ..Lining material_-.-....-.---------------------.---.Size: Diameter- -- ---------- --- --- .............Depth-------- ---------------------------------Liquid Capacity----------------------------g <br /> Privy; Distance from nearest well-------------------------- -- ---------- ----Distance from nearest building__--.-.---_-----.-___-__----.----...-.-. <br /> ❑ <br /> uilding------------------------------------ <br /> F1Distance to nearest lot line------------------------------------ ----- = ------------------------------------ ----------------------------------------------------.-. <br /> Remodeling and/or repairing [des c`ribe):-- ------ --------------------------- - -------------------------------------- ----—-------- ------- ----------------------------------------------- <br /> ---------------------------------------------------------- -------------------- ------------------------------------------------------------------- ------------------------------------- ---- -------------------------- <br /> ---------- ----------------------------------- ---- <br /> ------------ --------------------------------------------------------------------------------------------------------------------------- - ----------!__------------ <br /> - , I lt_y( <br /> -- ---------'----------------------------------------------------- <br /> ri�accordance w i fh San Joaquin County <br /> I hereby certify that I have-15re-pared this application and that the work will be done i <br /> ordinances, State laws, and rules4.and regulations of the San Joaquin Local Health District. f <br /> ;6P i nc dr ------------------------------------------ -1-------------------(Owner and/or Contractor) <br /> .....a"- -------------------- --- --- ---- <br /> (Signed)---- - - - -- <br /> ...(Title) <br /> - ------------------------ --------•----------- ------- --- ---- ------------- --- ------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, 6Uildiniqfs, etc., can be placed on reverse side). <br /> -FOR DEPARTMENT USE ONLY <br /> ---------------- AAPPLICATION ACCEPTED By---------- ------ - -6-2 ------------- <br /> REVIEWED <br /> 6-2 -------------REVIEWED ------- <br /> BY------------------- ---------_J............... ------------- ------- --------------------------- ------I--------- - ---- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------- -- ---------------------------------------:---------- ----------------------------.__ DATE----------------------------------- ------------------------- <br /> Alterationsand/or recommendations ------- ........ ----------- - - ------------------------ ------------------------------W-------------------------------------------------- <br /> ------ ------------------------ ------------------- ........ ....... ------- --------------------------- ............. --------------------------------------------------------------I------------ <br /> ---------- --------------------------- ------ --- -- --- ---------- -----------------------------­--------------------------------- -------r---------------- ----------------------------------------------------- <br /> ---------------------------------- ............... ................... --------------------------- ------------------------------------------------------------------- -- ---------------------------- <br /> ............. -- ----- --------------------------- I ..... ........ ---------------•-------- -- <br /> - -------------- - ------------------------------ -------------------------- ------- --- ----- <br /> ---------------­------- <br /> FINAL INSPECTION BY:-------- ---------------- Date--------3* 7-e!5- <br /> ---------- ----------- ---------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi.California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />