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-A. <br /> FOR OFFICE USE: <br /> i <br /> �.......-......5. ..... APPLICATION ' <br /> FOR_SANITATION PERMIT Permit No. . �• _._..__...._... <br /> ............................................... -• ------ (Complete in Duplicate) <br /> ._...__ This Permit Expires 1 Year From Date Issued Date Issued <br /> I <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. <br /> This application is made in compliance_with County Ordinance No. 549. Fl,tJ; �2�._�YO --e2 <br /> �� "3:Z� , Gt�ri�'►e VSs u�O:� rl(f " y� <br /> JOB ADDRESS A D LOCATION._ R'.!.--%�re:u!y6_/...1p3 i4r °' . <br /> I _...----- --•- ..--•----- ...... Phone..:................ <br /> Owner's Name.__ - !_.. <br /> Address........I0,3-A.:?. ......�f.•.........•. -- --•----•--........ -- ------------•----••----.......................-------•.......•-•---••-•---- <br /> 4 <br /> QL <br /> Contractor's .... •-•--- ........ Phone................................... <br /> ;. ....-•-------- <br /> Installation will serve: Residence ['Apartment; House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> 5',0--Y ` <br /> Number of living units: .._...._ Number of bedrooms ._a2•.. Number of baths t...... Lot size ...:`..-_.--____..... ................................... <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table <br /> a > <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Q Adobe Hardpan C] <br /> Previous Application Made: (If yes,date........... ......l No g3 New Construction: Yes g� E] FHA/VA: Yes ❑ No [F]- <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 weil�i........Distance from foundation ----------------- <br /> ......_....Material-_ ---_--- - <br /> ....,.. _ <br /> No. of compartments_.�.___. -----------Size....3_xA'�-�---•.-•-Liquid depth_..._ ____----------.Capacity.�f •� O <br /> Disposal Field: Distance from nearest well__ r�D_ .....Distance from foundation..AP .........Distance to nearest lot line.__. ...! W <br /> • Number of lines............f_.__._:a_._.._... <br /> Length of each line._._-�`�..'O.-'...............Widti, of trench..d g.'------_--_-------- <br /> Type <br /> ___.____--._.-Type of filter material`.��____._.--Depth of filter material_1r................Total lengfih... 9 U__.:--..._................ <br /> Seepage Pit: Distance to nearest weIIIA 1-......_._..Disfance-- 'from foundation.-/.'.......Distance to nearest lot line.-, <br /> [Ly Number of pits.....I..............Lining material---Xp4- ------Size: Diameter__.%32. Depih_....-Zr......... ; <br /> fCesspool: Distance fiom nearest well--- ............Distance from foundation--------------------Lining material..........._-._.-.-_-__._..._.__-.-.. � I <br /> J ❑ Size: Diameter...................... .. •.--Depth..........................................----.-..._Liquid Capacity.---------------------------galls. <br /> Privy: Distance from nearest well....�......................................__...Distance from nearest building.........................-----...._..._._. <br /> ❑ Distance to nearest lot line---- ------- t'­­....---•------- ---•----•••--••--••-•.._..-•---•-•--_...--••••..........................­-------------- <br /> Remodeling and/or repairing 1�``rr'"� �' '"... <br /> ......` .._ <br /> ..........................---.......--•---•.................................................................. <br /> n <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, aO rules andre la 'onsfof the San Joaquin Local Health District. <br /> r <br /> (Signed) (Owner and/or Contractor( <br /> ( 9 )-•...---•....__---- _..__....__._._ ....._......-- _.._.... <br /> IBy:------------------------------------------------------ ...._. .......... ... ----• _._._... ......(Title)...._-..---......--. <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc., can be placed on reverse side). ` <br /> i FOR DEPARTMENT USE ONLY <br /> J <br /> APPLICATION ACCEPTED BY---..._...---- --5-------- .-.� ........................ DATE-_.-----.-------------------------------------------- <br /> BUILDING <br /> -� �y ��...._._. <br /> APPLICATION <br /> REVIEWEDBY...........................................................�................ i <br /> BUILDINGPERMIT ISSUED.................................... ---••---•----•---••----------------- -.... DATE....................................------------------------ <br /> Alterations <br /> -..--•---------------Alterations and/or recommendations:....................+............_.............--•--.._.....---......... .._...._•---•-------•--------•-•---•----•--•---•-•-------•---..-----•-----• 1 <br /> ----•-..---•-•----...-•-------•---------•---•-•-•--- •-•...... <br /> ......................................................................•......_...... <br /> 1 ........ ......................................................................................................................................................••---••.....••-•-•-•.._....••-•--•......__.._.......:......---------•.-•---• r <br /> } .1'. <br /> .............. .......... <br /> .. .... ...................•----....-•----..................:....-•--•---..._...........---....._................_..........._......_....__........_............. <br /> ... ..............._.9..-• ............................................................ •-•------.-....-......---------.---------------------------------- <br /> G FINAL INSPECTION BY:.........-.f�..�_ ../i.�..L/.���^-- ......_. Date............. ......................•--..._.�� <br /> I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT J <br /> t _ <br /> 1601 E.Hazelton Ave. 300 West Oak$treat 124 Sycamore Street 205 West 9th Street a <br /> Stockton,California Lodi,Colifornia Manteca,California Tracy,California <br />