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FOR OFFICE USE: <br />-------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. W/ <br />--------------------------------------•------------- - <br /> " omp(Clete 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 /> JOB ADDRESS AND LOCATION -------- <br /> -- '----------------------------- [-'�l� <br /> Owner's Name------- --- --- ------ -•-------------------=----- =- -------------- ---- - ------- Phone-------------------------------_---- <br /> Address <br /> -----•---- �_�. U �f �Ahl __al� b` •--------- <br /> t - <br /> Contractor's Name----- V <br /> _t -----� r--------------------------------••--•----------------•--- Phone.'f i / <br /> Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I--_ Number of bedrooms _3___ Number of baths 1_ Lot size ------ --------4/1W4_5Z-X__)------------ <br /> "' Water Supply. Public system ❑ Community system ❑ Private-f�T'Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 3--'Hardpan <br /> Previous Application Made: (If yes,date--------------------) No Z New Construction: Yes 2"-No ❑ FHA/VA: Yes ❑ No.�" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septicTtank-orxcesspool,permitte.d,.if public seyv_er.�is available within_200,feet.),r <br /> Septic Tank: Distance from .nearest well____ ~_____Distance from fours ation __-/0___,_-- Material__ �/v -0-747'_________________ <br /> ©' No. of compartments------------ <br /> --___. ��-_.-_Size_ __fl _ ._ __Liquido�depth — -___Capacity__1� 0____ <br /> Disposal Field: Distance from nearest ell___ -_-_Distance from foundatio --------Distance to nearest lot�line____ � o <br /> Number of lines_________ ..--Length of each line____________________ Width oftrench.__ _______.___-.__._-___-___ <br /> - - --- -------- <br /> Type of filter materia ____. _ ____Depth of filter material___-_ __________Total length---------9- --------------------- <br /> r <br /> _----______--___- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation__________________Distance to nearest lot line___________-_____ <br /> ❑ Number of pits-----------------------Lining material----------------------Size: Diameter--------------------"__Depth--------------------------.------ �f <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------.--_-------..Lining material------------------------------------- <br /> Size: Diameter------------------ -------------De Depth----------------------------- cit Liquid Capacity_ ❑�.-. _ _ � - p q Y------------I - - -----gals. <br /> Privy: Distance from nearest well-------------------------------- __________".Distance from nearest'buiidin~'_'" <br /> ❑ Distance to nearest lot line--------------------------------------------- --------------------- --------------------- ------------------------ -•------- <br /> a, <br /> Remodelingand/or repairing (describe)----------------------- -------------------------------------------------------------•- --------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------- ---------------------------- '1! <br /> --- <br /> --------------------------------- --- ---------------------•-•-----------------------------------------------------------•---------------------------------------------------------------------------- --------------------" t <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 3 <br /> ordinances, State laws, and rules and regulations of the San JoaZLocalealth District.(Signed)- ---LI60Y_- ?,%)----------- --- --------------------- ------------------- ------------------------------------------(Owner and/or Contractor) <br /> --- --- — _ :r: (Tule}_ --�-- --- -------- ------ <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side}. <br /> A <br /> F R DEP RTMENT USE ONLY € <br /> APPLICATION ACCEPTED ---- f------- ---------------------------------- -------------------- DATE------- � ��(°---------------------'- ' <br /> REVIEWEDBY---------------- ------------- - ------ - --------------- -------------------- ------------­---------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT IS ED--- ---- --------------- DATE-------------------------- ---- - <br /> Alterationsand/or rec endations:-------------- ------------------------- - ---------------•------------------- ---•--------------------------•------------------------------------------------ <br /> --------------------"-------------------------------------- -- ------- -----------------------------------------•- - ----- --•-- ---------------------------------------------------------------------... <br /> ---------- ----------------------I- ------------------------------------------------------------------------------------------- ------------"---- --•-•-------------------•-----------•-----------------------------------_--- <br /> --------------------------------------------•----- ---------- - - ------ --------------------- ------------ ------------------------------------------------------------------------------------------------- <br /> I <br /> F€NAL INSPECTIO Y: Date �1 SS-- ----- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hat:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California ` Tracy,California <br /> d <br />