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FOR OFFICE USE: ;, <br /> APPLICATION FOR SANITATION PERMIT Permit No. .6_��--_-.13 <br /> ---------------------- -----•----- ------ (Complete-in Duplicate) 6� <br /> Date Issued <br /> -------_-.----___ . _ ..--- This Permit Expires 1 Year From Date Issued o±- -- -`�-----. <br /> Application is hereby-made to fhe San Joaquin Local Health--Districefor a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance .No.. 549. <br /> JOB ADDRESS AND LOCATION '�� �------],�Z ------------ `= -r -c-'-- "`7 <br /> 0 <br /> Owner's Name-- .. .. . . ------- 6 Phone <br /> Address_..........:.....•• !0!-_1>t -�`M -- ------ ---" - - ---�4 7 -`':' AIC- --_-----_---------- <br /> Contractor's -` --------------------- -----_-----•---- <br /> Contractor's Name--- U---------------- --- ------ Phone--.--- -----•---------------------- <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --- Number of bedrooms -Z-- Number of baths_9-._ Lot size JOW- -.__(1-_ ------._-__-- <br /> Water Supply: Public system ❑`_Community system ❑ Private D<°Depfli fo Water'Table---- `ftIN <br /> — <br /> Character of soil to a depth of 3 feet- Sand Er Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: {1f yes,date_--_j'_.._---_-. } No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <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 weH50'_'+__-Distance from foundation__ae-------.Material ---.{'ous✓c k'- ._-__-- <br /> No. of compartments----' ._ ......Size--------------------- -----------Liquid depth------.-- ----.-- ........Capacity. -- -- -- - - <br /> Disposal Field: Distance from nearest well'50.{ ...Distance from foundation-10-At.-n-.Distance to nearest lot line--. .------ <br /> Number of lines.----_�•_-_ �.' Len th of each line-- -__. Width of-trench-.- ._-. -��------------ ------- <br /> k - 9 _ 00---------- c <br /> Type of filter. material- _-Depth of filter:-material-----A-9------.--.-Total length--------- Q -------------------- <br /> I ' <br /> Seepage Pit: ',` Distarice totneares' ell.........---_--.._--Dist nce•from foundation--------------------Distance to nearest lot line--.---..-._._-_.. <br /> ❑ Number of pits... --------.._Lnng material------ I- Size: Diameter - <br /> Depth <br /> Cesspool: Distance from•nearest well ----------------Distance from-.foundaf on...,..:..--.._..- :.Lining material-_-_ --- --------..----_.-.--- <br /> ❑ Size: Diameter- -- -------------- ---------- -----Depth--------------- ---------------------------------- Liquid Capacity----------------------------gals! I <br /> Privy: Distance from nearest welt---------------------------_----------.---------Distarce from nearest building-.---------------------------------------- <br /> El Distance to nearest lot line --- ----- ------------ ---------- - ------------------------------------------------------------------- <br /> ----------------------------------- <br /> Remodelin 'and/or repairing describe ------------------------------------------------------------------------------------------------------------------------------------ i <br /> ---------------- =------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------- �f <br /> r , <br /> ---------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--- ------------------------ <br /> ------------------- ------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------ <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)--,-- --- --- --------------- A � ------ - .. .- .-( wn <br /> .-.. Oe and/or Contractor) <br /> By:------- ------ -- ---------- - ---------' -------------(Title)- - - ------ ---- -------- ----------------------------------- <br /> (Piot plan, showing sit 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------oZ-'-�-�--"-�?--�--- -------------- - <br /> REVIEWED BY------ ----------------------------- -------- --------- --------------------------------------------- ----------------- DATE <br /> - -------------- <br />( BUILDING PERMIT ISSUED-------- -- ------- ----------------------------- ----------------------- ------------ DA-TE--- -----------•--------------------- ------ <br /> Alterations and/or recommendations:----------------- --------------------------------- ---------------------------------------------------- ------------------------------------------- <br /> i <br /> --------------------•----- -------- ------...- ------.----------- --- -- ------ --- <br /> l FINAL INSPECTION BY:.e__ _ ---... _. Date---..._.. ... -_--{4_. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> S: <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> ' E.H.9 2M 1.67 Vanguard Press <br /> f- <br />