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FOR OFFICE USE- <br /> ------------------- <br /> SE--------------- --- ------------------------------- <br /> - ----------- <br /> 6 APPLICATION FOR SANITATIC:,4 PERMIT Permit No. . <br /> ..--------1- ------- --- -- ---------- --- ------- (Complete-in Duplicate) S— t <br /> Date Issued <br /> ...................... ---------------- This Permit Expires 1 Year From Date Issued <br /> .-----'�._------� <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 -------- -------------------------------- <br /> Owner's Nam ' w ta4• Phone! - <br /> Address--------- <br /> e------------•-•---•--------•--------------------------------------------------------------------------------------•-------------------- <br /> Contractor's Name .... .. Phone.. ..... i <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel '❑ Other ❑ <br /> Number of living units: -- ----- Number of bedrooms _ - --- Number of baths -------- Lot size ----- --- -------- ---------------_-_____.__--___-_.___ <br /> Water Supply: Public system ❑ ,Community system ❑ Private Depth to Water Table 46 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 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 availa6le within 200 feet.) <br /> Septic ank:T Distance from nearest well__ -------------------- <br /> -------------Distance from foundationMaterial -_-----______ __ <br /> _._-____--- --._.. <br /> C3�� No. of compartments.------------------ -----Size--------------------- ---------- Liquid depth--------- - - - - Capacity----------------------- <br /> ? � . <br /> Number of lines _-_--_ Q__---------Distance to nearest lot line._--._... <br /> Disposal i d: Distance from nearestell._ -- ,Length of tance rom each line_ of trench.._ -. ------------------- \' <br /> Type of filter material-11W -A...._..Depth of filter material-.-/t'_f__..____--Total length-.-......aO-_'.-___--__-_-___---_ V <br /> Seepage Pit: Distance to nearest well.100_1----------Distance from foundation-__G _-.-------.Distance to nearest lot line___ <br /> Number of its... - -- <br /> p ,_____________Lining material �t-L. _._. Size: Diameter.____ ._ ... -.._.-_Depth....... -.._______._---. <br /> Cesspool: Distance from nearest well .......r .-------Distance from foundation................. . Lining material---_------------.___.____-.--_-_-_-_ <br /> ❑ Size: Diameter- - -------- - --- -------------- Depth-------- - -- ------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well................:�,. .............-Distance from nearest building------..-.__-_-_.__-_.__-_-____-_------.-. <br /> ❑ Distance to nearest lot line ------------- ----------------------------------------------- ---------- - <br /> Remodeling and/or repairing (describe) ---- ---------------------------------------------------------- -------- ---------------------------------------------- <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 mulles and regulations of the San Joaquin Local Health District. <br /> C ----(Owner and/or Contractor <br /> (Signed)-------------- ------ ---- --- -- -- ------- - - -------- - -- - ---- - --- ---------------------------;.....- -- -- - - - ( � I <br /> By: --- ------- --------------- ---------------------- ----------------------- <br /> ------ -- <br /> i _-(Title_- <br /> (Plot plan, showing size of lot, location of system in relation to wefls;tbuildings, etc., can be placed on reverse side). <br /> f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ---D7:P----------- --------- - DATE_- Slis r' -- - <br /> ----------• ------------------ <br /> REVIEWEDBY-------------------------------------------------- ------ ------ ------------ ------- ------- -------------- ---------- DATE--------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED.------- -- ------------------------------------------ ---------- ----------- ---------------1------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations-------- ---- - - -- ---------- ------. ---- ----------- ------------------------------------ ---------------- ----------------------------------------- <br /> FINAL INSPECTION BY:-.... ..-R-V .----- Date.--s� rl-� K <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Naaelton 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 />