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-______________ . . _t`. <br /> -- -- ----------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _! T___ . <br /> - ---------------------------------------------- ----- - (Complete in Duplicate) .2 <br /> -------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued ____411 <br /> I 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 NoL:Z- <br /> 9 <br /> II{rIrI JOS ADDRESS AND LOCATION...... C1_--�--L'/---------------_ - •-------- -- - ---------- .. /-----... ------�--------------- <br /> ri, Owners Name---------•--I 4•-- -' --------• <br /> Address----••-------•-•---•----------------------1-A-1 1... � <br /> Contractor's Name------- ..... �-- t------------------------ ---•-----•-••---------------------•----------- Phone__ 7 <br /> Installation will serve: Residence X_' Apartment House ❑ Commercial ❑ Trailer Court ❑ .Motel ❑ Other ❑ <br /> Number of living units: __/_ Number of bedrooms :__:1fNumber of baths __j... Lot size --------------_______ <br /> { Water Supply: Public system �& Community system ❑ Privatecj] .Depth to Water Table 4sft:. <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 'Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: [If yes,date---------------------1 No ❑ New Construction: Yes El 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 Tank: Distance from nearest well_____:________-Distance.from foundation-----_--------------Material____-_-_--________________-_-_--.--___________- <br /> ❑ 4c-'544A/7-No. of compartments-•----------------------- Size_. = ----------------Liquid depth--•--=:--------------------- pace <br /> ei <br /> Disposal Field: Distance from nearest well Qr___.Distance from foundation.,(?_-_----_..-..-Distance to nearest lot line.._1.,�____.... <br /> I Number of lines___0-1�7___�Cj----Length of each line_.] __- __.Width of trench__ ___�_ -_�._.__________ <br /> Type of filter material---j�-- Ctk-Depth of filter material----�__�_��--------Total length._...------ Wil__!_----__--__ G <br /> # Seepage Pit: Distance to nearest well------------______----Distance from foundation--------------------Distance to nearest lot line................. <br /> ❑ Number of pits-----------•----------Lining material-----------------------Size: Diameter------------------------Dept h---------------------__ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--- _-__---.,__--.Lining material_____--___________.________----.-__. <br /> ❑ Size: Diameter--------------------------------------Depth---------•-------------•----------------------------Liquid Capacity=---------------------_-gals. {� <br /> Privy: Distance from nearest-well---------_---------------------------------------Distance from nearest building--------___________ <br /> ❑ Distance to nearest lot line------------------------------------------------•-----•-----•-•------- ----------------------- <br /> e <br /> Remodeling and/or repairing (describer-- ------- - -•----- ---------- ------------------------------ <br /> .. .-._.-... 1 <br /> -----------------------------------------------------------•------------- ---- --- -------- -- -- -. ---- - --- - ----------------•--------------------------- G <br /> -------------•-----------------------------I--------------------------------------------------•-------------- --------------- ------------------------------- --------------- ...... ------ <br /> -------i----------------------------------------------------------------•------- ----....-----------------------------------------------------------•------------------------------------------------------------------- <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, an s and regula+ions of the San Joaquin Local Health District. <br /> I rr <br /> r <br /> (Signed) �� L — - -------(Owner and/or Contractor) <br /> �Y� �•��.5. 1 �-`-- .ht --------(Title)------ s- --------- ---- -------------- <br />'r <br /> (Plot plan, showing size of lot, location-" f system in relation to wells, buildings, etc., can be place onside). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------•-- DATE----•--.�:!,:X-=--K ---------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------•-------------------------------- DATE-------------------------------•----------------------------- <br /> Alterations and/or recommendation ------------------------- -------------------------- -------------------------- ----•-----------•--------••----------------------•----...._----•- <br /> - 4_ n '. ------- °----------------------------------------------------- <br /> r <br /> -------------------------------------------------- --------------------------------------------------------------------------------------------------- <br /> - - •-- <br /> --------------------------------------------- -------------------------------- ----------------------- --........-- -•-------- <br /> , cc <br /> FINAL INSPECTION BY:------6_- ---•--------------•-----------------•-------- Date-- � <br /> h <br /> . SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911%Street <br /> II +�^ Stockton,California Lodi,California Manteca,California Tracy,California <br />