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FOR OFFICE USE: <br /> - S --------------- <br /> APPLICATION FOk "SANITATION PERMIT Permit No. . ..................... <br /> ---- -------------------------- --------- (Complete-in Duplicate) oZD X 1i <br /> -------- ---------------- This Permit Expires 1 Year From Date Issued Date Issued 3-- ---------- <br /> !v <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 N 549. <br /> JOB ADDRESS A�NYD CATION-_--___t <br /> --- ------ - - ------ ma ------ -----------------------,-----w-----------------�--? -----,-�-- <br /> Owner's Name - ----------•--------------------- ------ --- ---------- . Phone --- <br /> Address.......0:21,,R-3---- - ---------------------------------------------•------- ---------------•------•----------------------------------------- <br /> Contractor's Name--- ,10147-7—----------------- ---- ----------------------------------- ------- ----------------------------- -----------. Phone-------------------------- ------ i <br /> 1, <br /> Installation will serve: Residence (R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _f____ Number of bedrooms__ Number of baths, ,l <br /> ------- Lot size --.0�.-- -- --Lig------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Z Depth to Water Table eo ft <br /> Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay o Adobe o Hardpan ❑ <br /> Previous Application Made: (If yes,date_---- ------- - ) No ® New Construction: Yes ❑ No Yj 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.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation....................Material --------_`_____------------------------------ <br /> ❑ jLiSfrlo� of compartments----------_-------------Size-------------------- -----------Liquid depth---- ----'------ Capacity----------------------- <br /> e J J J <br /> Disposal Field: D's ance from nearest wefi.. Q._._..._Distance from foundation__/_1�7__..._....Distance to nearest lot line...w1. _..__. <br /> � e of filter` materiaV ---------------Length of each line-- -------6d_..._�! ---Width of trench.._'p /------------.--------- <br /> umber of lines._________ _ <br /> yp Depth of filter material----/.�______. _._ g <br /> Total len th 1-� <br /> C-4 <br /> Seepage Pit: Distance to nearest well_fox2-,...-------Distance from foun ation____a9�7__�___.Distance to nearest lot line_.S____..._ "�1 <br /> Number-of -------_.Lining material_'"" _0244 Size: Diameter------3eO.. ......De th_.. _ <br /> ------ -- ------ <br /> Cesspool: Distance from nearest well ________________Distance from foundation----------------- ..Lining material_______...._____._____,._J_______. <br /> .❑ Size: Diameter- -- --------- ----- ----------------Depth----------------------------------------------------Liquid'Capacity-------------- -------------gals. <br /> Privy: Distance from nearest well----------------------------------....-..........Distance from nearest building__._________..____.__.___``......... <br /> ._. <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe:-___ p_._. __ v___ __. _ __. _'"� � .__._.- <br /> A <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).__ __.._._..__._._._ .__.:._..__(Owner and/or Contractor) <br /> � '�---------- - - --- -- -- - <br /> By:----------------------------------------------------------------- - ----- -------- - - -------------(Title)----------- ---- ------------------ ----- <br /> t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION..ACCEPTED BY-;, - e - DATE...... .""- <br /> REVIEWED BY ---------------- ---- - - ---------------------------------------=-- ----- DATE----------- ------------- <br /> - - -- <br /> BUILDING PERMIT ISSUED-------- -- - ------------�--------- ------------------------------ ------------------ ---- ---------- DATE----------------- --------------------------- ------------- <br />` Alterations and/or recommendations:-------fy._.a...T----0-----A---------------- f �1:�-- �--- ---------------------------------------- <br /> -------­­---------------------------------- .......... ------------------------------------,-------------------------------------------------------------------------•--- -------------------------------- --------- <br /> ----------------------- ------------------- .------. -- --- ------ ------ <br /> -- <br /> _.._..-_---------------------------------------------------.__......__..._..._..--------------------------------------------------------------.---.: --------- _. ._... ------------------------- <br /> 4 <br /> FINAL INSPECTION BY:.-___- ___.2_ _ _. Date.......... ._ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1641 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi. California ,h Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />