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f-UK ut-1-K-t ust: <br /> ----------------------- --------------------------------- <br /> -------- ---------- --------- <br /> --------------------------------_____________________________ ___----_----- ------------- APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> ------- ------------------- - ............. (Complete-in Duplicate) f <br /> ........ This Permit Expires 1 Year From Date Issued 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 OCATION__� ± .. -- -rn.�: s-.�. d.. <br /> Owners Name------- --- -- ------ -- = . --------- Phone_ ,- ------- -- -- ••------•------•----••-- -••---• <br /> Address---------------- <br /> Contractor's Name---- <br /> -- ,@���_____ �---- .-_-- <br /> ------------------ ------- ------- =------------ • -- •--------------------._... Phone.__._...-------•--•-•-••--••---._.. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: /..... Number of bedrooms J_- Number of baths. -_. Lot size <br /> v Water Supply: Public system ❑ Community system E] Private Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan <br /> Previous Application Made: (If yes,date------------------- ) No E] New Construction:. Yes ❑ No E] FHA/VA: Yes El No ❑� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ <br /> Septic nk: Distance from nearest well ___1p......Distance from foundation----/_,U-.�-------Material .... _ &L4Z_...._____.- <br /> ------------------ <br /> IV <br /> No. of compartments-____7------.___Size.�_�!� _� x _S.' Liquid depth....q__'..... .._..--Capacity..�u_L _ ..-.-... <br /> Dispos Field: Distance from nearest well_.._SA4-------Distance from foundation--t-0_...........Distance to nearest lot line_---- _j.�___ <br /> Number of lines ______.___ ________________Length of each line-- --__S4-----�:`� Width of trench_._.;- -------- <br /> ---------------- <br /> Type of filter material----.__ _. _ ____Depth of filter material__. .t!.--_-___.Total length_--- ' �__..................... <br /> Seep e Pit: Distance to nearest well-.__�_ P-�----Distance from foundation---..rl� --------Distance to nearest lot line_�_�__-_...__ <br /> p _--.-.Lining material__-_6�-�Z.____ Size. Diameter__-- _3�-._-_---.Depth_.. -x.'.__- �. <br /> Number of its--- --- ------- ------------•-- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation_-..-.----------- ..Lining material--------------------- _-.-------_-__ <br /> ❑ Size: Diameter- -- --------- ----- --- .........Depth------------- -----------------------------------Liquid Capacity---------------------- -----gals. <br /> Privy: Distance from nearest well-------------------------- ----------------------Distance from nearest building_.--.--____._..-_--_._._._---..--..---_.-. <br /> NNW <br /> ❑ Distance to nearest lot line -------- - ------------ - ----------------------------------------------------------------- - <br /> Remodeling and/or repairing (describe) -= ----------.�•--------- --------•-••------••------------------------- <br /> ---•--------------------------------------------------•- ........... -.--- - r a .� ---- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) - --- ------------ Weser and/or Contractor) <br /> ---- - ----------- <br /> By <br /> --- ---------------- <br /> sY '`-------- - - --------•- --- ......---------- ........{Title)---------- ---------------------------- .. . --------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> nn-- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._!�"_. . /s'*-� s� DATE 2-y ^G. <br /> REVIEWEDBY------------- ----------------------- ------- --------------------------------- ------- ----------------•---- --------------• DATE-------- - ------------------------------------------------- <br /> BUILDING PERMIT ISSUED-------- -- ------------------------------- ---- ------------------------------ ----- - ------------- DATE <br /> Alterations and/or recommendations:------------- ------------------------ ----------- ------------------------------- ------------------------ ---------- - <br /> ----------•--- <br /> --------------- .......................................... ­-------- ---- Z------ <br /> FINAL INSPECTICN BY,;.t. i _4Y1 •G = -------------- - Date.- -.;- 4 " <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 />