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FOR OFFICE USE: <br /> �. <br /> / - ------ --------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------- <br /> sf a ►, <br /> -------------------- --- -----------------5UP,7 (Complete in Duplicate) ?� <br /> Date Issued <br /> ----------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 3_Y <br /> JOB ADDRESS AND LOCATION._._____ O_--,Z_rF______-__� -� <br /> ----------------------------------------------------------------------------------------------------•------------------------ <br /> i Owner's Name---------------4_11?------_1474, <br /> - -- ------------------•--•-••-------•--------------------- - --------------------------------------- ---- Phone------------------------------------ <br /> A' <br /> Address----------------fid <br /> ----------- <br /> Contractor's Name----------- <br /> ---------- .......... t...fs>% ,._ Phone__ E_ _d _ _.. <br /> 1 ------------------------ <br /> Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1____ Number of bedrooms __ Number of baths [._._ Lot size ------- --------------------------- <br /> Water <br /> ---------------------Water Supply: Public system Er Community system ❑ Private ❑ Depth to-Water Table _______ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe [ Hardpan ❑ <br /> I Previous Application Made: (If yes,Idate--------------------) No [`�j— New.Construction: Yes ❑ No E3— FHA/VA: Yes ❑ No E <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1 } <br /> t <br /> Septic Tank: Distance from nearest well_______________Distance from <br /> t foundaton __________________Material____-_..____...________ <br /> .______----_--________- <br /> �t � No. of compart�encs-�- �- - ------------Size-----•-•-----------�-----------_Liquid de th-_._____________________Capacity----------------------- <br /> Disposal Field: Distance from nearest well,-4,�q--------Distance from foundation---/3------------Distance to nearest lot line__=r_._____ <br /> [� Number of finest---------- ------------- Length of each line---------- --------------Width of trench_- : �-----------------.----- <br /> Type of filter material-_ ----------Depth of filter materiaI____!X-"_______._notal length______��_�-_________________ <br /> — <br /> Seepage Pit: Distance to nearest well.___h10-----------Distance from foundation____ 1_-Distance to nearest lot <br /> �- r S I Number of pits-�.--�-------------Lining material Diameter---�-�--r-.----------Depfh_.__2-_.-.-------------.---- `) <br /> Cesspool: Distance from n I earest well-----------------Distance from foundation---------.------____ Lining material--------------------------_-____..__. <br /> Size: Diameter-- ---------- ------------------------Depth-------------------•---------------------------=----Liquid Capacity-:--------------------------gals. <br /> Privy: Distance from neares _____t_..____.._ <br /> __--____._-____--______Distance from nearest building------------------------------- <br /> ❑ Distance to nearest lot line_+________________________ <br /> -------- <br /> Remodeling and/or repairing (descr.be):------. . ---• ' x ----- <br /> ---------------------------------------------------------- <br /> ----------_--------------------------------------------------f_---------------.______.__E._____________-____________________-_____________________________---_____._____._____.__.--.____.--.-_-_-_.._______._________.___. <br /> l _..__________._________-__________________ --------------------------- <br /> _- ________. <br /> ------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.------ yl <br /> f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin CountyI <br /> l ordinances, State laws, and rules and regulations <br /> /of�San Joaquin Local Health District. <br /> (Signed) <br /> `--------------- -----------------------------------------{Owner and/or Contractor) !I <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 /> r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- t/ --------- - ---- ------ --------------------------------- DATE------ <br /> REVIEWEDBY ----------•-------------------- --------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED-----------I-------------------------- - ------------ ---------- TE.--------- <br /> Alterations and/or recommendations____________________ :�r` - ��,`_------_ ------------------------------------------- <br /> -------------------------------•----------------- - <br /> -------•----------------------------------------------•------- ------ ----- ------------------ ---------------------------------------­­------------------------------------------------------------------------- --------- <br /> ------------ <br /> FINAL INSPECTION BY:--- ---------------------------- ----- Date. ----------- ` .------------------ <br /> SAN JOAQUIN LOCAL 14ALTH DISTRICT <br /> i <br /> 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi;California Manteca,California Tracy,California <br />