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FOR OFFICE USE: 1?0 c <br />-----------� --- - ------- - ----- -- ----------- - - e./f <br /> APPLICATION FOR SANITATION PERMIT Permit No. - ------------------ <br />----- ---------------- - - ------------- ----------- <br /> (Complete-in Duplicate) Date Issued -�J�--� � <br /> -------------------------- --- This Permit Expires 1 Year-From Date Issued <br /> Application is hereby mac!J4o the San Joaquin Local Health District for a permit to construct and install the wor erein d cled. <br /> This application is made in compliance with County Ordinance No. 549. L <br /> JOB ADDRESS AND LOCATION •. wwo,7 e-`-�'---- /i e ` <br /> Owner's Name---------------,�r�__r'-- --�....... --- ----- ------ - <br /> ------------------- ------- ------ Phone------------------------------------ <br /> Address------------- <br /> -----------------------------------Address------------- - <br /> Contractor's Name �e _ ----------- - ---- ----------------------------------------------- Phone---------------------------------- <br /> Installation will serve: Residence ®impartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units-. f.--- Number of bedrooms - ... Number of.baths J--- Lot size _r 4ZA079-�-�--------------------------- <br /> Water Supply: Public system 'El Community system ❑ Private U?/15epth to Water Table ft <br /> Character of soil to a depth of 3 feet'- Sand E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_- ---------._----- ) No gal" New Construction: Yes Zj--No ❑ FHA/VA: Yes Z__ No ❑ I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ter. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} ` <br /> Septic Tank: Distance from nearest well._��--Distance from founds ion__._A0F....... Mat r) _ '/----------- -- <br /> -No. of compartments-_A--------------------Size_' __1_.11l Liquid depthCapacity_1.Z- _,0__--- <br /> Disposal Field: Distance from nearest well 4a_-_..Distance from found /ation-_ ._.Distance to nearest lot line_--'s. ...... <br /> t <br /> w%" Number of lines.---_�-__i---f___�..j- __-�.�_jjLength of each line__ __.Width of trench._.----------------- <br /> Type <br /> _.-_...�.._.__ .._ <br /> Type of filter material./.-gJ��4 Depth of filter material-_-_ .._-.-.--Total length..... Q_:___---_---.-.---- <br /> Seepage Pit: Distance to nearest well_AP ---_-_.,Distance,ffj�om f�o�u'dation.._r _� Distance to nearest lot line._+ .�1-._ <br /> r Number of pits... Lining mate rialUC -Size: Diameter._:,- Depth-.24_.................... <br /> Cesspool- Distance from nearest well ----------------Distance from foundation----------------- - Lining material--------------------.----------.--_-.. <br /> ❑ Size: Diameter- ------ ----- ----- - -------Depth-------- - ---- -------------------- - ------------ Liquid Capacity----------------------------gals. <br /> Privy: Distance from•r7earest weli-------------------------------------------------Distance from nearest building---------------------------------- <br /> 0 Distance to nearest lot line -------- -------------------- - ------------------------ -------------------------------------------- -------------------------------- - <br /> Remodeling and/or repairing (describe) -..c�_�s ll 1 '. / _rA(Zf17-------------------------------- ------------------- <br /> -----------•-------------------•------------------------ ---------------------------- -------------------------------------------- ------------------ <br /> ------------------------ -----------------------------•------------------------------------------------•--------------------------------------------------------------------------------------------------- <br /> ------- ------------ ----------- -------------------- j-----------------------.-----:----------------------------------------- ---------------- ------ --- -------------------------------------- <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) - q� ............. ------ --- --- -- ------------------------------ ---(O*n@LwWor Contractors <br /> B '--- -------------(Title)....(Plot plan, showing size of lot, location of system inr ion to wel{s, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ..... - --- ------------------ - ------------ DATE--- _w__ ----- ----------------------------- <br /> REVIEWEDBY-----------s --------------------- - ------------------ --------------------------- I-- -------------------------- DATE----------------- -•---------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------- -------------------------------------------------------•--- --- --- --------- DATE----- -------------------- -- -------------- -------------- <br /> Alterationsand/or recommendations:.............. ........ ---------r --- --------------------------------- ----------------•-----------------------------------------------•------- <br /> ---------- ------------ - -------------------------- ------- ----------------------------------------------------------------------------- -- --------------------------------- -- ---------------------------------- <br /> ----------i ------ -- <br /> ------------------------ ------- -------------------- -- --------------------------- ....------------ --------- <br /> -FINAL INSPECTION BY:...� - -- -- _._._ ``-------------- Date._C ..+_a--_— d._._.--- .---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton 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 />