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FOR OFFICE USE: <br /> ................_____... .__-_._-_-- - APPLICATION FOR SANITATION PERMIT Permit No. .. ......_____._____..__ <br /> w <br /> ------ - —----- - - - ------n (Complete-in Duplicate) <br /> -------------­---- This Permit Expires 1 Year From Date Issu ld Date Issued <br /> �# �5 0__0� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to cdnstruct and install the work herein described. <br /> This application is made in complia e.with County.Ordinance No. '549. <br /> f Df <br /> JOB ADDRESS AND LOCATi --- _L\----- -------"`---- c-- - f ------- <br /> Owner's <br /> -----Owner's Name------------- <br /> Address <br /> {_ ?--------- j' �'- <br /> ...- ` ------ ------ <br /> --- <br /> -------------------------------------------- Phone--------------------- ------------ <br /> ----------------------- <br /> ----------- <br /> Address t - � -------------------•- • - <br /> Contractor's Name (�� '3ta = - Phone------ ---------------------------- <br /> Installation will serve: Residence []/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livin units: __�____ Number of bedrooms __ __ Number of baths_ Lot size . - <br /> g ---- -------- ---------------------- <br /> Water Supply: Public system E❑ Community system C] Private Depth to Water Tables�. ft ! <br /> Character of soil to a depth of 3 feet- Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan E <br /> Previous Application Made: (If yes,date................__ 1 Noe] New Construction: Yes r No ❑_ FHA/VA: Yes <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--_--3f- ..:-Distance from foundation---/0-----------Materia --------------- ------------ <br /> No. <br /> ---:--_-_No. of compartments..._. _-------._. Size_Yf1n Y7-_ ------- ---Liquid depth___. Capacit f.- ---------- <br /> Disposal <br /> - p <br /> Dis osal Field: Distance from nearest well--... ?. �....Distance from foundation---___ ` <br /> p � ��..-__- .Distance to nearest lot line! �________. <br /> ❑ Number of lines ---___.-_'L•�---_-__--._-Length of each line__ ._/ `.-__._.i�----Width of trench__-.--__2` _______ _____ __ <br /> Type of filter material--- 1._.Depth of filter material-------- _____.._Total length---------------------`5z-2 <br /> Seepage Pit: Distance to nearest well---------------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits--- ------------ ----Lining material---.-------------..--- Size: Diameter----------------------Depth_..___..------------------_------ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation_.....................Li'ning material-.-_.-....__....___.___-----_-____ <br /> El Size: Diameter- .. --------- th--------------- ---- ---.-- _-_-- <br /> ----- ----------------De - • . Liquid p - --------------.Li q Capacity- ---•-------- -- ---------gar <br /> Privy: Distance from nearest well------..............--- - --------------.-..-...Distance from nearest building------------------------------------ <br /> - <br /> ❑ Distance to nearest lot line------------z •----------------- --------------------------------- <br /> Remodeling and/or repairing (describe):------ -------------------------------- ------------•----------------------•---------------------------- --------- --------- <br /> - - --------- ------------------------------------------- <br /> -------------------- ------------------------------------------------------------•-------------- - ---------------------------------------------- <br /> -------------------------------•----------------•------- --------------------------•--------------------------------------- ----------------------------------- <br /> ----------------------- ------ ------ ---------------- <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, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--- �} w-"- ' -" - t_' - --.—.--.-(Owner and/or Contractor). -. <br /> By:------------------------------------------------------------------ - -----•--------------- ---------------- ----------------------(Title)----- ----------- - ----- ------------------- - <br /> (Piot plan, showing size of lot, location of system in relation to wells, bu'dings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT SE ONLY <br /> APPLICATION ACCEPTED BY _..._._f_ I._ �.t_._.____..__- ------------ <br /> ---------------- --- ------- DATE--------- <br /> REVIEWEDBY---------------•------- - ------------------------------------------------ - -------------------------------------------- DATE <br /> -------------- <br /> BUILDINGPERMIT ISSUED---- -- -- ---•--••----- --------- ------------------------------------------------------- --------- DATE---------------------------- ------------------------------ <br /> Alterations and/or recommendations:--------• ---------------------------- --------- -----------..------------------------------•- <br /> - ----------------------------------------•-------------- -------------------------------------- ------------ ------------- ----- --- --------------------------------------- ------------------------------- <br /> -- -•--------------- - ------.._. .. I . --------------------------------- ------ ---- - ----------------- <br /> ---------------------- ............ --------J�.! .- - -.-.-:- --- -- - - <br /> FINAL INSPECTI Date- - --------15_'z . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Californla Lodi California '"a` Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br /> 4r <br />