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-2--------------------"-I C <br /> APPLIt :TION FOR SANITATION PERMITPermit No. <br />.......­­---------- ---------------- --------- (Comple+e-in Duplicate) <br />............ ----- --- --I--------- ---------------- This Permit Ex fres I Year From Date Issued 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. <br /> JOB ADDRESS AND LOCATION----11__?Jt-------Sk�N_ ------)?0_412---- ------------ 2a�..,v------------------------------------------- <br /> Owner's Nam....... 5-•-----Xs..... -----------••----------- ------- -- --- ------------ ---------- ----- --- --- Phone_•�-(--_-S­ <br /> Address----- 7------o-------- ................ --------------------------------------- -----------­ -------------------------- <br /> Contractor's Name------ ------5•=� ile------------ ----- ----------------------------------- ------- ---------------------------------------------- Phone.....................--•- --------- <br /> Installation will serve. Residence N Apartment House ❑ Commercial 0 Trailer Court 0 Motel E] Other E] <br /> Number of living units: Number of bedrooms Number of baths Lot 'Size ----- -- ------------------------ <br /> Water Supply: Public system ❑ Community system E] Private N Depth to Water Table .J4- ft <br /> Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy Loam 19 Clay Loam El Clay El Adobe El Hardpan El <br /> Previous Application Made; (If yes,date................... ) No JR New Construction: Yes CH No El FHA/VA: Yes El No 21 <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-----?v......Distance from foundation------M_i------Material <br /> No. of compartments...........Z-------- Size---- Liquid depth....... capacity_/.��. V..G.44, <br /> Disposal Field: Distance from nearest well._._ Q Distance from foundation----- ----------Distance to nearest lot line- � <br /> Number of lines.--•-------------r. <br /> Length of each line-- --.---7 `...---...-.Width of french-.-------X�-_ <br /> Type of filter materia �;T! Depth of filter material..._ Total length.........lj7G'....... --------------- <br /> Seepazju-"i Distance to nearest ---------------Distance from foundation--------------------Distance to nearest lot line....-............ <br /> Number of Its... ..... ...2-------------Lining mate Size: biarn <br /> El eter C_Depth_ ------- ........ <br /> Nucle <br /> Cesspool: Distance, from nearest well .....--.__.._--Distance from foundation.. I I <br /> ............... . i material....... ---- ---------------------- <br /> ❑ y <br /> Size: Diameter- -- ------ -- ----- ------- ........Depth--------------------------------- ..................Liquid'Capacit ............................gals. <br /> Privy: Distance from nearest well._..._ ------ - -- - - ------Distance from nearesf building. . --------------------------------------- <br /> 0 Distance to nearest lot line ------- - - ------------­ - ­­----------------------------------------- <br /> Remodeling and/or repairing (describe):...... --------------- --------------------------------------__----__---------------------------- -- ---------------------------------------------- <br /> ---------------------------------------------- --- --- --------------------r... --------------------------------------------------------------- ---------- ---------------------------------------------------- - ------ <br /> ------------------------------------------------------------------------- --------------------------------------- ---------------------------------------------------------------------­­­................ <br /> - ------------�;----------- -------------------------------------------- --------------r-----------------------------------------------------------------------------------*------------------------------------- - <br /> I hereby certify that I have prepared this application a'nd that the work will be done in accordance with San Joaquin County <br /> ordinances., State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-------------------......... -------------------------------- ............... - - -------------------------------------- ------------- ----(Owner and/or Contractor) <br /> By:..............----------------------------------------------------- ------------------------------------r-------------------------(Title)---------......-- ---I--- ---- ----------- ------- - ------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ---- ----- ---------------------------------- DATE-- <br /> REVIEWEDBY----------------------------------------------------------- ---------------------------------------I--------I----------- DATE------ <br /> BUILDING <br /> ATE------BUILDING PERMIT ISSUED----- -- ------------------------ ----------------------------___­--------------- ----------------- DATE-- ----- - <br /> ---------------- -- ----------------------------- <br /> Alterations and/or recommendations:_- -----------6 ---- ---NTT-------31EV - ---------- --------------------------- <br /> ............ ............ -------------------- ......11........ - ----------- <br /> ------- ---------------------------------- <br /> ------------------------------------------:------------------­­_­------ -----------------------------I----------------- ------------------­----------1---------- - ------- ------------------ ------ ---------------- <br /> --------------------------- ----------------­----- ----------- ---------------------------------------------- -------------- ----------------- --- --­..... ................. ---------- <br /> ------------------ ------------- <br /> FINAL INSPECTION .................... Date......�1 <br /> --- - —---------- ----- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxeltan Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi. California . Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />