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F�tOFFICE USE: <br /> ------- «, rr'- - APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <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. 544. <br /> JOB ADDRESS AND OC TION_ _ , ---- <br /> Owner's Name-------__ _ <br /> -------- ----- ---- Phone_-------------------- <br /> 1-1010e <br /> Addressdc1 ` tem. ". ? <br /> Contractor's Name.___.r__- _ � 1 <br /> - - -�-----= - - -- - <br /> ----------------------------------- - -------------------------- •---------. Phone..................- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel p Other ❑ <br /> Number of living units: _e_ Number,of bedrooms _$/- Number of baths _ -. Lot size _��4t-t�--'` 1r <br /> ----•------- ------ <br /> Water Supply: Public system ❑ Community system ❑ Private R?<epth to Water Table _ ls ft, <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E-] Clay Loam ❑ Clay ❑ Adobe Erllrdpan ❑ <br /> aI <br /> Previous Application Made: (If yes,date_____-.-_...__, f No �_ New Construction: Yes�o ❑ FHA/VA: Yes a-­�No ❑ <br /> TYPE OF INSTALLATIONAND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta Distance from nearest w le _ 6 <br /> p } �� _ Qisfiance�rom foundation __ Matenal__�-�r � __ __-_-___------- <br /> No. of compartments__ Size. . <br /> ---- --------- " X515" iquid .depth---- '"-------=------Capacity . <br /> 40, � <br /> Disposal Field: Distance from nearest well-- ....Distance from found t' n_ ___ Distance to nearest lot line_ <br /> Number of lines--__�Z _.-Length of each line___ ____-_ Width of trench- <br /> 1 <br /> Type of filter mafierial/�' - _Depth of filter material__ _.__.__.-Tofial len th_- N ' <br /> f <br /> Seepage t: Distance to nearest well__- , __-_Distance f m fo dation__0/�--_____. i ace to nearest lot line <br /> All _ta'�~� <br /> Number of pits-- rr Lining material�A�- - -n-.Size: Diameter i <br /> ------ <br /> Cesspool: Distance from nearest well-------________�_Distance from foundation--------------------Lining material------------------------- <br /> ❑ Size: Diameter--=--'--------------------- -- -------Depth-------------------------------------=--------------Liquid Capacity------------------------ -gats. ° <br /> Privy: D stance from nearest well_________________f----_ .____-__-_ --Distance.from-nearest buildin <br /> ❑ f 9 :P=-------------------- <br /> Distance to nearest lot line______________ __ <br /> Remodeling and/or repairing descril6e :________ rr <br /> ------------------ --- <br /> ------------------------ -----------------------------------------------------------------------------------••- \----- ------------------------------------------------------------------------ ---------------- - <br /> t - <br /> -------------------------------------------------- ------------------•------------------------------------------------------------------- --------------- <br /> f hereby certify that I have prepared this application and 4af 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 /> �.. <br /> (Signed)- -------------------- -- --- -- <br /> ----------- --- --- rContractor) <br /> By: - --------- ------------ " --------------{Title)- <br /> (Plo+ plan, showing size of lot, location' of system ' elation to wells, buildings, etc., can be placed an revue), <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ � �" •••_ • -S'-" <br /> - r -------:...••. -------------------------------------- DATE------ --- = <br /> REVIEWEDBY -------------- ------------------ --- ---------------------------------------- DATE !. <br /> - - - -------------- <br /> -----------•-------� ------- <br /> BUILQING PERMIT ISSUED ---'------- -------------------------- --- -------------------------------- ------ DATE I <br /> Alterations and/or recommendations:____--__-'�� -rZT_-_� ?`` P _ �—t�_ ����� <br /> �aC -----•--------•--•---- --•------- <br /> --- ------`'.--------- ----- ---------- ---------------- -- --- <br /> -------• - <br /> ------ -------- --------- -- -- --- -- <br /> -----------------------------------•--- - C <br /> ------------------------------------- <br /> --- --------- ----- <br /> 3--��--�--- ---�---- ---- -- <br /> . <br /> FINAL INSPECTION BY:----- -------- ---- ------------------------------------ Date----------- . _- p t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ~r <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> I Tracy,California <br /> EB 9 REVISED B-59 31A .3•'63 F.P.CD. ; <br /> s <br />