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Vis- - -------- - <br /> ---_-_---------------------- ------------------------ '\APPLICA11U.-4"FOR SANITATION�"RMIT Permit No. .... <br /> ------------------------- ------ ------------ ------ (Complete in Duplicate) ff <br /> ------------_---------------------------------___________ This Permit Expires 7"Year From Date Issued <br /> 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. b f'( 6(00-0/ <br /> --------- <br /> ��/ _ ' �bb�v' ` <br /> JOB ADDRESS AND LOCATI N._.s_-. �' `� <br /> - ----------------------------- <br /> Owner's Name----------- Qtit7 - Phone3 <br /> Address----•-• <br /> n <br /> Contractor's Name �-------------------------------------------------------------- ----- Phone---��--•--- - <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ . Other'' <br /> Number of living units: .-Z Number of bedrooms -__-__Numoer of baths -------- Lot size ------ - ---—-- '`�� <br /> Water Supply: Public system ❑ Community system ❑ Private L9­5epth to Water Table 11 1_X tt. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoamkEr-t-lay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No Vj/New Construction: Yes Kj--No ❑ 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 , a k: Distance from nearest well. -----Distance from foundatipn-----ZP .._.Material_ <br /> No. of compartments----------'h--- Size_4�. -t2.-x� iquid depth____.___._-1•_.__..._Capacity---— ------ <br /> 40 <br /> ---- ------ <br /> Disposal Fi Id: Distance from nearest wel1...-�...��.....Distance from foundation../e�___.Distance to nearest lot line---."r-1 <br /> .. <br /> Number of lines--------------7�_____...._Length of each line------L-(---V _.-.___-Width of trench____��_ -__ <br /> �j -------------- -1 <br /> Type of filter material___�t �'_-z' �J_Depth of filter ------------V__ <br /> length..-.....PP---- ------------------ <br /> Seepage Pit: <br /> ----------------Seepage'Pit: Distance to nearest well...." --------Distance from foundation-----1.0�_-.9istance to nearest lot line-;., <br /> Number of pits-------Y....._..Lining material-_w __ <br /> - Sc .Size: Diamefer._ �_e-'_0 _.Depth_.__._. ----------------- <br /> Cesspool: Distance from nearest well------.----------Distance from foundation--------------------Lining material__..___._______.___._____._.._. ' <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-.--------------------------gals. <br /> Privy: Distance from nearest wefL.. -----_...__..._..__...Distance from nearest building._______._..__-------------------------- <br /> ❑ Distance to nearest lot line--------------------------------- --------------•---------------•------------------------------------------------------------------------------4f <br /> Remodeling and/or repairing (describe)------------------- ----------------- ------------------------------------•----------------------•--------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- <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 la and rules and regulation of a San Joaquin Local Health District. ._ <br /> (signed) {Owner and/or Contractor) <br /> By:------------ ------------------------------------------`----------------------------------------------------------------------(Title)------------------------------------------------ ------------ - <br /> (Plot plan, s ow' g size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY--------------------------------------------------------------------------------------- ---------- DATE--------------------- --------- ---------- ------------------- <br /> REVIEWEDBY------------ --------"-----------"---------------- -------------•---------- ----------------------------------------------- DATE%-------------"----------------------•----------------------�• <br /> BUILDING PERMIT ISSUED-------- ----------------------------------------------------'------� ------- DATE--- --t--- <br /> Alterations and/or recommendations:-------------�i� L� --------- <br /> ------ - <br /> ---------...------------------------------------------------------------ --- - ------------------ ----------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:... -r0ak <br /> <S l ` v <br /> Date------ / <br /> SUIN LOCAL HEALTH DISTRICT / <br /> 1801 E.Hazelton Ave. 300eet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CC. <br /> L =J <br />