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i FOR OFFICE USE: <br /> 9 <br /> .........,+................._....................I........ APPLICATION FOR SANITATION PERMIT Permit No. 21?Zay...... <br /> i <br /> -------------------------------------------------------- (Complete in Duplicate) <br /> .... t .. . . .............................. ..___ This Permit Expires 1 Year From Date Issued Date Issued_ b?O o7 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r <br /> Phis application is made in compliance with County Ordinance No. 549. lt <br /> (5.77 :s/.�/4- <br /> ------------------------------ <br /> JOB ADDRESS AND LOCATION--- = ,1°�' �G%l '% `. ✓ `' ' f�7� ` 5`� ""- <br /> ------------ <br /> 6wner's Name.-------------J/-*_ _f ........ -•------- �/------------------•-•--•-•---••------ Phone,�i�.1-.,i�_%K...... <br /> Address-----------------------.-�.7....I- �_Q.� a�/._f1 /�G--------x"-°�-/..------------------------------_.-.-------._..-.- -------- -------•------------ <br /> Contractor's Name - � <br /> -------- <br /> Installation <br /> 1 ' ' --•-•- <br /> In stallation will serve: Residence 0-'Apartment House F] Commercial [j Trailer Court [j �Motel E] Other El <br /> Number of living units:'? Number of bedrooms_ . . Number of baths //;�_5/_Lot size -Z--------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [fl-"Depth to Water Table -------- ft. 1 <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑r,Clay E] Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date._._ .._. ..___) No []--New Construction: Yes ❑ No E ---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 /> i <br /> Septic Tank: Distance from nearest well.................Distance from foundation...................Material................................................. <br /> s ❑ No. of compartments_-------------------_Size.---•.-•-------•--------• ----.Liquid depth..........................Capacity--._-----------•------ <br /> j <br /> + <br /> Dis osal, Field: Distance from nearest well_���'..�.._Distance from foundation._/._fir_. _.....Distance to nearest lot line.__5.c�3--__-__- <br /> 0 Number of lines.......�......_-------_.__..__Length of each line._._ 9!�.`______________Width of trench---%'�. ------------- <br /> )lType of.filter mate rial. fjl ,.C�.....Depth of filter Total length_. _.3d `__ _____________________ <br /> Seepage Pit: Distanc6 to nearest we.! P_19..._..-_-.Distance fr m foundation__ <br /> ,/�. ��..........Distance to nearest lot line...._..__..___.._ <br /> Number of piti' '.�1............Lining material__ fly _.--Size: Diameter----7-?.`t.......Depth_•�_. __.`I�. <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material.............................._..... <br /> Size: Diameter----- .Depth.... -----•----------•-- ----------------- -••--Liquid Capacity -•---gals-..,. <br /> a <br /> Privy: Distance 'rom nearest well-..-______---______._..........................Distance from nearest building........................................... <br /> ❑ Distance to nearest lot line...................:.....•-••-•-----------------•-•------------------------------------•--••-••---•--------------- ....................... t <br /> Remodeling and/or repair'ng (describe:.... t. 1 ...._._ �l� .f'_/S l/J►� C `=� 141V............................... <br /> c <br /> --------------­---------­ ------------------------------------------------------ -------------­------------- ----------- ••--•-••=...................................... <br /> --- ............................................... .....................................-...----------------------------------------------------------------------------- .................-------------- <br /> # I hereby certify that I have prepared this applicatio and that'+lie work'will�e`d �in accordance with San Joaquin County <br /> ordinances, State lawsa rules and regulations of the San Joaquin Local Health District. <br /> � � V <br /> i ned r�1 Ie. S`L ----;--... .../f�_ . ....................... ..... Owner and/or Contractor) <br /> { 9 ) ----- <br /> • • - --- •-- ------------• ----- - -. -- ------------ <br /> B I � ,--f � �' •�^ Title) -� <br /> f <br /> (Flo+ plan, showing size of lot, location osystem tri relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY > ...................................................... DATE.../0.' 3 ------ -----------------• I <br /> REVIEWEDBY....... ...................................•.---............---._.----------..-----•-.-------------------------------------- DATE_.........--------.----- ---------------------------- i <br /> BUILDINGPERMIT ISSUED...__----------------------------•---•---•--------------_••------------------------------------ DAT E........-.......------------ ......................... <br /> Alterations and/or recommendations:..................-------------------------•------------•--•-•--•----------•----•----------------------•---n................................................. <br /> ----------------------------------•-----............................................................................................-...................................................... <br /> ........................................................ <br /> f <br /> FINAL INSPECTION BY:_.. . .. ................ Date---- ............... . ........... <br /> f SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasel►on Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> N <br /> 1 <br />