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FOROFF CE USE: <br /> = � �-------- ------ <br /> -_____ APPLICATION FOR SANITATION PERMIT Permit No. <br /> -_-- <br /> „--------------------------- {Complete in Duplicate) Date Issued �O�l =�-6 d <br /> _--------------""".--"_."""-""__."--.""_"_-" I'This°Permit Ei ires�l 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 Ordinan a No. 549. <br /> JOS ADDRESS AND L ATION____- --------------------------------- <br /> - <br /> Owner's Name = _ ----- ---- ------ ---------- <br /> -------------------------------- <br /> Phone. = <br /> - - - -------- <br /> 3 � - <br /> Address . .�_' �-------------7-------------------- <br /> " '`�• <br /> Contractors Name. = ............... Phone_----_--•--•----------- <br /> - ------- ---�-�------------- <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms .,,;L Number of baths _/.. Lot size .> - /__P ' "------------------------- <br /> ti <br /> Water Supply: Public,system W Community system ❑ Private ❑ :T Depth to Water Table Vp W <br /> Character of soil to a depth of 3 feet: Sand E1 Gravel ❑1.. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: (If yes,date--------------------I No R;0001Qew Construction: Yes ❑ No g4o--FHA/VA: Yes ❑ No 91, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank ar.cesso0 <br /> permitted if.public sewer is available within 200-feet.) �. <br /> P P P <br /> Septic Ta Distance from. Barest well-":'" "*-".__Distance from foundation" -.��__----Materi L".��� - - • <br /> No. of compartments----�-----------------Size. _ ---Liquid depth-----�;_ ,r_ -----.-Capacity... ---- <br /> DisposalField: Distance from nearest'well.--"---"-._--".":Distance from foundafion----------------"---Distance to nearest lot line----------------- <br /> r <br /> �j� Number of lines------ <br /> -------------- ----- -Length of each line-_--------------------------Width of trench------------------------------------ <br /> Type of filter Material------------------------- of filter material-----------------------Total length-----------------:_-----__---_-_.---------� <br /> epage Rif: Distance to nearest;well---------------_-----Distance from foundation--------------------Distance to nearest lot line.-.----.--..."_-- <br /> ;T�� Number of pits------L --------Liningr material------------------------Size: Diameter------------ ---------Depth_-------------••-----•--- <br /> Cesspool: Distance from;nearest well-----------------Distance.from foundation_----------.-..-_--Lining material-------------------------------------- <br /> - <br /> ❑ Size: Diameter!----------------------------------- Depth---------------------------------------- To- Liquid Capacity gals. <br /> t i f <br /> Privy: Distance from nearest well---------------".-.------------------------------Distance from nearest building--__-"„----_-"-.-_--__---_-----------."-. <br /> ,- r <br /> Distanceto nearest lot.line-----------------------------------------------I----------------------•------ ---------------------^----------- ------------------- - <br /> ' I <br /> Remodeling and/or repairing, (describe)-----------------/b�s�ss/- <br /> - P � .-" �3�C�c_�C�' --mo o` ,n- - .". err t �'�l —r.------ " <br /> a <br /> C "f c --- <br /> _""Yt�'�"-�A -ems// � <br /> t <br /> _________ -------=---------------------- - ----------------------------- <br /> I'hereby certify that I have'ptepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rul s and regulations of the San Joaquin Local Health District. <br /> c y <br /> 9 {© Contractor) <br /> ------------------- --- -(Signed) •-~-------------------------- ---(Title)---- -- <br /> BYE <br /> (Plot plan, showing size of lot, lova, of system in relation to wells, buildings, a+c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY".. -------- •=----------------------------- f1---------------------- <br /> REVIEWEDBY------- -------------------s----- --------`---------- -------------------------------- `------------- ••-.-- DATE <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------•--------a-----------•----------• DATE----------.,---.------------------------------------ <br /> Alterations and/or recommendations:""__:-"_":." ---------------------­- ' ---•'••"-=-•••-•'- <br /> ----------'------ -- --------------------------•---------- ----------•------."."-"--------._----------"-----------' <br /> ------------------------------------i---------------------------._- ----------------------' <br /> ---------------"-----------------------"------------------ •------------------------"-----------"--"_.------------------- ., <br /> _."-------------""---•_.-.-"----.-.-.-"_- --_-_--------------------";---------"..."."-----"." <br /> l <br /> FINAL INSPECTION BY:r_r".- ..__". . - Date. <br /> SAN J�OAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak 51ree1,�•a1 124 Sycamore Str e1, "i 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E9-9 FEvIseD e-59 F.P.co.2M 6-6o <br /> +Y- <br />