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FOR OFFICE USE: <br /> .............------:................................ <br /> -•• APPLICATION FOR SANITATION PERMIT Permit No. .1.7f�.._....... <br /> (Complete in Duplicate) Date Issue --- -- <br /> .___.__....•.._. ------- This Permit Expires 1 Year From Date Issued <br /> r.pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereii�ribed. <br /> This application is made in compliance with County Ordinance No. 549. SSS- <br /> JOB ADDRESS AND LOCATION­ <br /> .�._�... ......"..r_-.--.-- - .......'.•F-•"•�•t.. <br /> . <br /> ................Owner's Name... <br /> _._..._.. <br /> r <br /> I" <br /> Address.---.ALZ...t .Z.. .....................rte 'sq1. .!f?- <br /> -V1 <br /> - <br /> Contractor's Name. �i /i -ail + Phone---•-----------------------•------- <br /> Installation will serve: Residence M Apart int House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1.. Number of bedrooms ...lf�"NNumber of baths _J... Lot size _.__.__..__:-�_...�.-•-•-----------••-------•-- <br /> Wafer Supply: Public system ❑ 'Community system ❑ Private tj Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ) Adobe❑ Hardpan ❑ <br /> es C] Not <br /> Previous Application Made: (If yes,date....................) No [- New Construction: Yes JK No ❑ FHA/VA.Y <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic. _ f Distance from nearest well.................Distance from foundation____-------.----.-.Material-------------------------------------------------Tan <br /> � <br /> V. No. of compartments size.--•................ ... Liquid depth_... Capacity..... <br /> i <br /> Dls o al f=ield: Distance from nearest well...ISQ....Distance from foundat"on.....�.1 V.......Disfience to nearest lot line---------------- <br /> Number of lines.......-q......................Length of each line.. <br /> 9 --Width of trench. . ................... <br /> Type of filter material ._Dopth of filter material.....�..5'_....._...Total length.__.). G�......................... c�c <br /> /- Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line_____..._..._._.. C <br /> [] Number of pits......................Lining material.......-...............Size: Diameter..._.------------------Depth..-.-..._--. ----.---.-•-----••� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material---------------------------......als. <br /> ❑ Size: Diameter......................................Depth....................................................Liquid Capacity--••---• -----• _.l?1 <br /> Privy: Distance from nearest well...................................-.............Distance from nearest building-------.-.-_-------.----.-- •----•-•- <br /> ❑ ---------------------•--------- <br /> Distance to nearest lot line............................................................................... .-_-•--..... <br /> Remodeling and/or repairing (describe):...... ................•-•----........ ................................................................ <br /> .. <br /> -••-••-•-••...................................................................................................... ....................•-•-----•----••---- <br /> ..............................................................------------------....................... �. <br /> ---------•- -•......................•--••-------._.........--•••------••----••---•-•---•-•---•••--•••••---••----•--••-•--•-•---•----------•------•-••-.........---•....-•---...._........----••-•-.........._..._....elf <br /> I hereby cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County t <br /> ordinances, Staf lbws, and rules andrregulations of the San Joaquin Local Health District. <br /> (Signed)._. D - (Owner and/or Contractor) <br /> .... -•• ••-••--•--- <br /> By:.....-•••--•-----••-••--- Title <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 <br /> APPLICATION ACCEPTED BY--------------------------------------------------------------- <br /> -------- DATE._... -• -•--...._......_......... <br /> REVIEWED BY-..-.._ �{ � DATE...---: <br /> :� , <br /> BUILDING PERMIT ISSUED.............................................................-.......................... <br /> ------•-•-- DATE-- <br /> Alterations and/or recommendations:.................................................. <br /> ...............................•--•-•---•---•-•-..._....•••••......_.__..............--•..........•-•--•---•--•-•--•----•-.._.... <br /> ... -- ..............•--•..•...._ .._.. ......... -----•-----••--•---•-•-•-••--••-•--•-•-•--•--------------.---- ..-. <br /> FINAL INSPECTION BY: .... ....._......_._...... ... Date.........---....... I�... .....�. .... ........... ._..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-S9 3M 3-•63 F.P.= <br />