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> -FOR OFFICE USE: <br /> 6 y� APPLICATION FOR SANITATION PERMIT <br /> Permit No. ..!__... <br /> I (Complete in Duplicated Date Issued <br /> l --- - -------- ------ ------- <br /> f--____..__._ ---------- <br /> --- This Permit Expires 1 Year From Date Issue . <br /> Applicatign 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 LOCATIO --- ---------------- ---------- <br /> --------------------------------------------------- <br /> ------------------ <br /> [ Owner's Name---- ------------- ----- <br /> A r� .y, <br /> Address ?` !!"' .lfJ- ' -�' -- ----------------------- ---------------- ---•-------- <br /> OPhone----------------------------------- <br /> � Contractor's_.Name------------- -- - ------ - - -------------------- ----------- - - ' <br /> Installation will serve: Residence E] Apartment House [I Commercial ❑ ��Trailer Court Motel ❑�Ot�heer ❑, <br /> ,3 Lot size _.�d_� - lit 3 --•-----•... <br /> Number of living units: --A— Number of bedrooms _----__ Number of baths _ <br /> �� ft. <br /> Water Supply: Public.system,�ommunity system ❑ Private ❑ Depth to Water Table _--__ <br /> Clay [I Adobe [Hardpan 11Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ❑ <br /> Previous Application Made: (if yes,date--------------------) No Jer New Construction: Yes'�r No ElFHA/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 nk: Distance from nearest well --Distance from foundafion-_��__.-.____.Material_-- ep <br /> No. of compartments---- 9 .............Size---t��----XJ&---Liquid depth c ------Capacity� <br /> Disposal Field: Distance from nearest well. Distance from foundation/4--�_.= Distance to nearest lot Gne___.`>___.__._. <br /> Number of lines'._3---------------------------Length of each line---- d--------------------Width of trench,-, ._f --------------------- <br /> Number <br /> - h <br /> Type of filter materia[�OCk___--___Depth of filter material...�9-Y___-.__--_Total length--- ya <br /> Seepage Pit: Distance to nearest well---- �____.-.---Distanc from foundation-1p----______-___.Distance to nearest lot line. v~.._-_ -- N <br /> m�� , <br /> Number of pits-----'�-�-`-----------"Luling material-----------------------Size: Diameter._..33----------Depth---�`-�'r.------- ----• <br /> Cesspool: Distance from nearest well___._---___--.-Distance from foundation________________ ___Lining material__-_.__.___------ - els. <br /> ❑ Size: Diameter------=------------------------------Depth-------------------------------- -----------------Liqu;d Capacity- -------------------------g <br /> ` Distance from nearest building------------------------------------------- <br /> Privy: <br /> ----------------------- --------- --._. <br /> Privy: Distance from nearest well------------------------------- <br /> yV <br /> Distance to nearesttlot line------ -------------------- --------- ---------- -------------------- <br /> f <br /> Remodeling and/or repairing (describe--------- --------------------- ------ --------------------------------------_ -----------•--- <br /> -------------------------------------------•------ <br /> --------------------- ------------='-----------------------------------•------ <br /> 1 { <br /> 1 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 regulations of the San Joaquin Local Health District. <br /> I.. € "T� r Contractor) <br /> tiI ------------------------------------------------ ------------ <br /> By:--------- (Tit e) <br /> (Plot plan, showing size of lot,,location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t FOR DEPARTMENT USE ONLY <br /> ------------------- <br /> APPLICATION ACCEPTED BY / ''�_- DATE_..__ 1 = .. ' <br /> REVIEWEDBY-=-------------L------------'----------- ---------- ---------- ----------------------------------- DATE <br /> � --------------- DATE------"--------- ------------------------------------------- <br /> BUILDINGPERMIT ISSUED_---------!-- ------------ ------- ----------------------------------------------- <br /> Alterations and/or recommendations------------------------------------------------------- <br /> -------------------------------------------------------------------- <br /> 10 ----- ------------•------•-------- <br /> -------- ---------------------- ----------------- <br /> a <br /> Al <br /> 1' ---------------------= -- -- ------ - - - v� . f /7 <br /> /-may} - - -------- <br /> r y/.._'t----- <br /> -------- -.. _.__._.._ <br /> --- __-_•___ __. .. _ .._-.. ._._ - L <br /> 41 <br /> ------------------------- -------- . <br /> �/ <br /> ICN <br /> �--=-:-- --- <br /> ---------- <br /> �- F� Date-- ---- ---- - -- --- -- -• ----- --- --------------------------------- <br /> FINAL <br /> -------------------- ----- -- <br /> FINAL INSPECTION BY:.......... . ..... i <br /> OAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Lodi,California Manteca,California Tracy,California <br /> Stockton,California " <br /> F.P.CC- <br />