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FOR OFFIC -E- <br /> ----------- --------------------------------------- <br /> E:--a-.--. __._.-__________________________________ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------- ---------- --------------- (Complete in Duplicate) i <br /> .. .. Date.Issued ----• / i <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 /> Owner's <br /> -- -Owner's Name___ ._ ` _ <br /> ,_.. Address-- ,-�/ 14._..4SOt.D-- <br /> Contractor's <br /> Installation will serve: Residence [M Apartment House❑" Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___/___ Number of bedrooms -A--_ Number'of baths ---J-- Lot size ____7,3~ e_3/*-_______________________________ <br /> Water Supply: Public system (?] Community system ❑ 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 i <br /> Previous Application Made: (if yes,date____________________) No ❑ New Construction: Yes Ug No ❑ FHA/VA:,Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ;F <br /> 4 {(No septic tank or cesspool permitted if public sewer is available within 200 feet.)_ ' <br /> nSeptic Tank:- Distance from nearest well-----------------Distance from foundation- /P*-------- <br /> ^� <br /> ' •. ® � No. of compartments-_-'- ----_-----------Size--,4-k0-�.,k­�-_--_--Liquid d '00�epth------�f,�--------------Capacity--�"-0-g• <br /> Disposal Field: Distance from nearest well-_______--_-.Distance from foundation----/Q___---------Distance to nearest lot line-----4......... <br /> Number of lines_____________ `Len th of each Ime_ W!— -----------%34 idth of trenc ------ ______________.__ <br /> y � 9a <br />€ Type of filter material___'J?-jr._,4r-____Depth of filter material_____ZJFf----------Total length----------AYq`'-------:-____-__ l <br /> I,: r <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation----._._:-----------Distance to nearest lot line____-___-___-__.- <br /> i ❑ Number of pits------- ------------Lining material----------------------.Size: Diameter------------------------Depth----- ------------..------------- Q <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material _._-------_____-- <br /> .❑, Size:•Diameter---------------------------------------Depth------------------------------------------------------Liquid Capacity------=-------------------gals. <br /> Privy:. Distancefromnearest well------------------------------------±------------Distance from nearest building__`----__---.------..-------------------- ` <br /> I Distance to nearest lot line = _'-------------•----•------------•-•-------------------- <br /> i <br /> Remodeling 'and/or repairing (describe)__________________________ 1 <br /> --------------•-----••-----•----------------•--------------•--•-----•-•-•-----•-------•---------------------------------------------------• •------------------------ <br /> ►. i <br /> ---------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County s <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--- '" C ----------------------------------------------------------------------------------------(Owner and/or Contractor) <br />` `By:---------•......... .......I......- -- -- � (Title) <br /> --------------------------------------------•---- ------- ............... <br /> (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---- m! ---------------------------------- DATE---- ''_L--`-�-4'`'--)---------------------------- i <br /> REVIEWED BY---------------------------- ----------------- ---- -------------------. -I..._ ......--- DATE-------- ............... <br /> BUILDING PERMIT ISSUED--------------=-----------------------------------------•-•---------------- ------------------------ DATE----------------------'------------------------------------•- <br /> Alterations and/or recommendations____________ ________________..._: I a - - <br /> -•------------------------- -----------------------•--------------------------------• ------ -------------- ---------•--------------......... ----•-----------•----------------••----------------------------•------------ <br /> ------------- ---------------------------------•------- ----------------------------- ----------------------------------------------------------•----------------.....-------------•----------------------------- <br /> --------•-- - <br /> ------------------------ --------------------------------------------------- <br /> FINAL INSPECTION `BY:..r <br /> y --- -*---- ----------- Date-- ---- ---------------------- <br /> ��_.. .__ � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br />' Stocktonr California Lodi,California Manteca,California Tracy,California <br /> - E9.9,RE SEC 6.59 F-F-CC.2M 6.60 <br />