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FOR OFFICE USE: <br /> ____________ _z:` � _.. APPLICATION FOR SANITATION PERMIT Permit No. _. -- `C /__ <br /> ---------------- -- ----------------------------------- ' (Complete in Duplicate) Date Issued �k <br /> ------_ � `_____________._ _ " This Permit Ex ices 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 desecribed. <br /> This application is made in compliance with County Ordinance No. 549. x°""' <br /> JOB ADDRESS D LOCATION__P'- <br /> Owner's Name_. <br /> ' IL <br /> = <br /> one------------------------ <br /> ,r. -- <br /> Address ------ --------------------------------------------------- - ---------------------------------------------- <br /> Contractor's Name------ --•=�• f-------------------------------------------- ----------- ...... Phone----y --- 2- <br /> Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/____ Number of bedrooms _A___ Number of baths __Z__ Lot size ____�.z/ -.--------------------------------------- <br /> Water <br /> « ____________ <br /> _ _ _ -------- '------------ <br /> Water Supply: Public system �Community system ❑ Private ❑ Depth to Water Table -------- ft. N <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe a' Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No g�- New Construction: Yes RT No ❑ FHA/VA: Yes ❑ No [�J- a <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_---5-_v-------Distance from foundation----/-0_________.Material------------------------------------ <br /> [�^ No. of compartments-------Z-_____________Size---- -�--Liquid depth_____40. . -.__ ----Capacity-_R- __ ______ <br /> r I! <br /> Disposal Field: Distance from nearest well__�`�d__..._Distance from foundation____/n________.Distance to nearest lot line____:__._. 1 i <br /> [ ! Number of lines------- ------------------ ---Length of each line__/cv_`_- �:-----Width of trench----- -,--- ��---- -- <br /> Q-. <br /> Seepage Pit: Disanoceftloenear striwell____/�_4_________Distance f frlotmrfoundatilonl f'________ Distance ttohnearest lot line_ .__!` I { <br /> /�' -� <br /> I ❑❑- �` �SNumber of pits------41..... _ Lining material-1q-;?-4_ . -Size: - r• Depth--------,5'-P--- ------- <br /> ' pJ <br /> Cesspool: Distance from neares 'ell_________________Distance from foundation._.--.---^-_---_ __ Lining - _________ <br /> ize: iameter----- ----------- ------- ----------Deth--------------- - Liquid Capacity_. --------------------!- -gals.t 9, <br /> �# <br /> r <br /> Privy: Distencee'' romrom`n�ares#w I-------------------------------------------------Distance from nearest building----------------------------- <br /> -�--- -------.'x <br /> ❑ Distance to nearest lot line--- - - -------- ---- ------------------- --------------------------------------- -------------------------------------------1 e 2 <br /> il <br /> Remodeling and/or repairing (describe) - =----------• 1 <br /> -------------------------------------- ---------------------------------- <br /> ----------;---------------------------=------------- ------------ ,I <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 laws, and rules and regulati s off th�-Joaquin Local Health District. I� <br /> (Signed) CyA, T -- f-----------------------------------------------------------------Owner and/or Contractors i <br /> By---------------- -- --- ------------- ---------------_-----------------------------------------------------------------(Title)----- -------------- <br /> -------------------- <br /> (Plot <br /> ------ --Plot plan. showing size of Tot, location of sysfem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY - <br /> APPLICATION ACCEPTED BY-------- <br /> DATE `e °�- ---------------------------- <br /> REVIEWED -BY------------------------ ------------------------------------------ ---------- ----------------------------------------------- DATE----------------------------------------- <br /> ij <br /> ------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------- ------------------------------------------------------------- DATE------------------------------------ <br /> Alteratio and/or recommendations: --------------- ------------------------------------------------• - ---------•-- --------- --• ------... <br /> ,f <br /> -----:;5..!-�' ----(.'- -r---t -'� t -- `-- - --E ---~ 't- ----------- /---�--�-f-�- -!-�-�+---}---------- --`t- <br /> --&�_------------ --i ------- <br /> -----•------------------------ ------ ---- ----- <br /> ` <br /> a <br /> ------------- ----------------------------------------------------------- ---------------- ------- ----------------------- <br /> ---------------­ <br /> -------------------- <br /> ; <br /> FINAL INSPECTION BY_______________ _______ Date_ - II <br /> `s <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Ij <br /> 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California I� <br />