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FOR OFFICE USE: <br /> --------- APPLICATION FOR SANITATION PERMIT Permit No. ' <br /> ----------------- ---------------------------- a- (Complefe•in Duplicate) <br /> ----------- -- This Permit Expires 1 Year From Date Issued Date Issued _ -�B <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . <br /> This application is made in compliance with County Ordinance No. 549. /f <br /> JOB ADDRESS AND LOCATION " "___._ __._�_�_".---_-,-�-Q-r -- r---- <br /> Owner's Name [•t A7 <br /> 4• S ,� / - ----------------- ------------- <br /> <_ <br /> AddressPllorie_ <br /> Contractor's Name------- ------I--t------ Phone-r- ��,1�' ._7 <br /> Installation will serve: Residence JX Apartment House_❑ —Commercial ©,j Trailer Court ❑ Motel ❑ Other ]] <br /> Number of living units: _-I.___ Number of bedrooms ---Number of baths_ ___- Lot size __l - A._ <br /> �. <br /> Water Supply: Public system ❑ Community system [] Private 2�Depth to Water Table'/-jQ-,ft <br /> Character of soil to a depth of 3 feet Sand ]�Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date___________________ ) No ®KNew Construction: Yes ❑ No ❑ FHA/SVA: Yes [❑ No ❑ s <br /> TYPE OF INSTALLATIONAND SPECIFICATIONS: <br /> - -,, - i Y - , <br /> {No._septic.. mo <br /> tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--------'�...Distance from foundation----------------- Material.........________ <br /> ❑ No. of compartments------------- �',�Size-------------------- -----------Liquid depth--------- ----- --.Capacity----------------------- <br /> 'Y <br /> Disposal Field: Distance from nearest well. Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Number of lines.------------------------------...Length of each line-- ----.----------------------Width of trench----------------------------------- <br /> Type <br /> ----------------------_ --Type of filter material____.."_-----------------Depth of filter material------------- Total length_-._...-_----_--_.__---_--_-____.-__--__ q <br /> Seepage Pit: Distance to nearest well______--------fin _Distance from foundation------------------- Distance to nearest lot line__.------_-_ <br /> ❑ Number of pits.-- ------------.---Lining material-�------------------- Size: Diameter-----------------.-----Deipth...__------------------------- <br /> Cesspool: Distance fi-orrl-neo well ----------------Distance' foundation...._._ Linin material"_________________.____.._.__.______. <br /> ❑ -�Size'Ibiarrleter_ .. -------- .-.--_---Li ujd Ca acit <br /> Depth 9 _ P y---------------------------gals. <br /> Privy: Distance from nearest-well--�-__-:.................. ... .........Distance from nearest.buiId' ing .-•^,._._. ".- <br /> ' , <br /> ❑ Distance to nearest lot line - E----------------------------------------- ----�---V-- -111-1-------- <br /> �� i f <br /> Remodeling land/or repairing (describe) -�?p('�i°i�_o{(I C--`r <br /> ----------i06----------6F-------- <br /> t <br /> E <br /> _____________________________________'.________._________._._- "___________._-_f__-______-_---------------_-__.--_--_--__-_---_.----__---__. _ ______..____.____-_______._____ --._ <br /> F l f <br /> ---------- ------------------------------------------- -----------------------------------•----•-----=------- ----------------------------------------------------------•------------------------------------------- -- <br /> I hereby certify that I have prepared.this- application and that the work will I;e done in accordance with San Joaquin County <br /> ordinances, State I s, and ru sand regulations of th an Joaquin L.ocah"Health District. <br /> (Signed) �! / <br /> *•� - ---------------- ---------- <br /> -- .-. (Owner and/or Contractor) I <br /> BY: = = = =' _---_--- ------------------- ---- --------=---------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY __ T _!r' <br /> APPLICATION ACCEPTED BY------ `�"t --------------------- --------------------- --- -------------- DATE-- ----- <br /> REVIEWEDBY----------------------------------- ------ - ----- --------- ----------------- ---------------- --------------------•-------- DATE------- <br /> BUILDINGPERMIT ISSUED-------- -- -- --------------------------------------------------------- ----- ---------------------- DATE--- ----------------------- <br /> Alterations and/or recommendations------ -------------------- - --------- --------- ------- ----------- ----------------------------------------- <br /> ------------- - -•----. -w.y <br /> - -------------- ---------------------- <br /> --------------- <br /> --------------------- --- -- -------- <br /> .. . . . ----- <br /> = - _ _ - - <br /> FINAL iNSP Date----- ------. 7 I <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT � <br /> 1601 E.Hazelton 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 />