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FOR OFFICE USE: <br /> ..... ------------ -- -.--Z.........--------- <br /> --- - ------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. X..K:::.// <br /> ..... ... ...._......I........:--.•- ......... (Complahs-in Duplicate) Date Issued <br /> ................ .............. ............... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construit and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. $-.W ryz vr 0&dF.�fl <br /> JOB ADDRESS AND <br /> Owner's <br /> V.....-.-............. Phone...._............._.........-...... <br /> Name..... <br /> Address.......4 <br /> Contractor's Nam --------------I----------------------­......­ Phone...4.016� 74e ... <br /> Installation Will same: Residence E] Apartment House ❑ Commercial E] Trailer-goo X Motel 0 Other [] 7 <br /> Number of living units; ../.. Number of bedrooms ..2.--Number of baths Lot[] ft size _9 —---------- <br /> A &- <br /> Wafer Supply: Public system ❑ Community system [] Private Depth to Wafer Table <br /> Character of soil to a depth of 3 ferti Sand E] Gravel E] Sandy Loam El Clay Loam E] Clay[] Adobe ffHardpan C] <br /> Previous Application Made: (If yes,date.........._....... ) No [3 New Construction: Yes E] No4r- FHA/VA: Yes [] No 0 <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 weII_/.5_P_�Disfancp frorrlfo da.4on---Ila.......Material <br /> No. of compartments................. _Uquid depth....47lYtCapacity-J. <br /> Disposal Field: Distance from nearest well-1-seSZ.).-Distance from foundation-.14. ........Distance to nearest lot Iine.J%RZ?.f7 <br /> ;K Number of lines Length of each line-,9-0..i .__._........Width of french.-selVAr................ <br /> Type of filter nr Depth of filter material......i-q-1.1----.-Total length....4 . <br /> C ............ <br /> T -A <br /> Se Pit: Distance to nearest well.ee?__I/Af�"'Distancil fromjoundatiorR&.!�.......Distance to nearest lot <br /> 0Z Number of pits..._V------........Lining materialjgnn�.... .. ,...Size: ................... <br /> Cesspool: Distance from nearest well_....._......_Distance from foundation...................Lining material............_......._......_......_. <br /> M Size: Diameter--- __.. ..... _-----------.-Depth-------------- - ------ __ _... .......Liquid Capacity..............----'----'--gals. <br /> Privy: Distance from nearest well.... .........................Distance from nearest building.....-_......__........................... <br /> 0 Distance to nearest lot line.............................. ---------------...................__-------- ......__...... ....... <br /> Remodeling and/or repairing (descr <br /> 6 -----------1--------- -------------------- --------­----- ........................................................... <br /> ...............--__----------------------- ................................................... ........... ......... <br /> -------------------------------- ---------------------- ........................................................................................................... .... <br /> -----------------------: ------- ------ ----------- -------------­­--------------------....................I......I.,.......­....­--------------------------------------- <br /> I hereb certify fh a'f I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances WS. and rules I regulations of the San Joaquin Local Health Disfeict. <br /> (signad).._.....I "AMZ�--- -------------_ .. .... ............A40MR05ESt�er Contractor) <br /> By:...........................---------------------------------------- -- ....... _(rile).........._............ ----- ____... ................ <br /> (Plot plan, showing size of lot, location of system in relation to well-s-1 uIlding , etc-, can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_..---- ----- -----. ........__................................... DATE------ --------- <br /> REVIEWEDBY.................................... ---------- ------------------_--..................................__--------- DATE._.....-.........._ ---------------..................... <br /> BUILDING PERMIT ISSUED--------------------------------------...... ..............................------------__ DATE-----• ......................--......-----------'-- <br /> Alterations <br /> ............ ..............Alterations and/or recommendations:_.------- - - - -- ---------------------------------------------------- -------------- ..........................................------- <br /> ........................................................................... .. ........................-------------------------------------------------................. ..................... <br /> ...........................................................................I—---------_----------- ........................... ....................................­...............­­................ <br /> ...................... ..........•........................ ................I------ ......__...... ................................I——............................ .......................... <br /> --------------------------------------------------- ­-*--------**------------ <br /> ir -----------_------------ <br /> FINAL INSPECTION BY:__._ ------ ................... Da�te <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Moieties.Ave. 300 Wert Oak Sister 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Preis S.1.Z4 V 2-- <br />