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FOR OFFICE USE: <br /> �r __ _ - <br /> -•3_�--lr� ---------- -•..__ Permit No. �����-- <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------------------------------------- <br /> (Complete in Duplicate) L. Date Issued S'J'l -d� <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 /> ----------------------------------- <br /> JOB ADDRESS AND LOCATION-'� I_a <_: rG- _. `'---- ------------------ ------------------------- <br /> F/ Phone-------------- --------------------- <br /> -._- ---------- ------------------------------- ----- <br /> Owner's Name- - -'- � -`•-------•------•---• <br /> Address__ ---- - <br /> Contractor's Name---- '°� !--•----------I------------------------------------------ -------- ---------- <br /> - <br /> tSi - � Phone---------------•----------•------- r <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---I... Number of bedrooms <br /> Number of baths 4.... Lot,size ._l. t -------------•----------------------- <br /> ' Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ElClay Loam [:] Clay ❑ Adobe [Hardpan ❑ <br /> I <br /> No FHA/VA: Yes ❑ Nb _ <br /> 'Previous Application Made: (If yes,date_._._.__...--------) No 2`- New Construction: Yes.❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ' Septif{Tank ]� Distance from nearest well------------_----Distance from foundation___.-__.______.__.Material <br /> ___._______._-_________...__.__._..____.____.. <br /> �`; anj-' No. of compartments ---------- <br /> Size Liquid depth - Capacity <br /> t - liner <br /> Dispos Field Distance from nearest well-____.______-._Distance from foundation______-.y____._._.Distance to nearest lot _.____ <br /> � � -----------------Length of each 4ine---------4-7 -----------.Width of trench---------- <br /> Number of lines________.____._ _ <br /> of filter materiaL_______�4��,_..°.Total length__.___. ...... _ <br /> ___________ _---------- " <br /> t Type of filter material_____S'_P'---_--- Depth � <br /> Seepage Pit: -Distance to nearest well---1@Q_.--------Distance from foundation__.Q-__________:D�stance t-- nearest lot, ine__t:;?___-..___-_ <br /> Number of pits..E------------------Lining material_A =------size:,Diamete --.----Depth iiij <br /> (, g _ _ <br /> ' Cesspool:. Distance from nearest well ..____Distance from foundation____________________Linin material__:_______-----_---___._._-.------. <br /> Size: Diameter:���-.------• 7..777 _-_:Depth------------------ -------- ------------- --Liquid Capacity._------------------- 90 <br /> Privy: Distance from nearest well... _ ____________ __ <br /> ---�__Distance from nearest building------ ---------------------------------- <br /> ' _ _ � , <br /> ❑ f Distance to nearesf,0 line------------------- ------ - --- - ------------------------------------------------------------------- <br /> ` ._____--------------.---------------- <br /> _____._. <br /> F Remodeiing and/or repairing (describe)_------------------------------_� _____---______________________4_ -____.._________..________._._________ <br /> r ----------------------- --------------------------- <br /> ------------ <br /> ''' „; -----•------------------------------ <br /> --------- --------------------------------------------- --------------------------- <br /> ------------ <br /> s <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 /> : (Owner andC <br /> ------------- ------------ <br /> (Signed)---- �+ <br /> ------------------------------------------------------------------------------- <br /> Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> k- <br /> F EPARTMENT USE ONLY <br /> ` r ---------------------------------- DATE--------- --------------------------- <br /> APPLICATION ACCEPTED BY t ') <br /> REVIEWED BY---------------------------------------- ----- --- - ---- <br /> - ----- --- ----------------------- --------- DATE------------------------------------------------------ ---- <br /> - -----------—-------------------- <br /> -------------- DATE------------------------ -------- -- ----=------------ -- <br /> BUILDING PERMIT ISSUED--------------- ------- <br /> Alterations and/or recommendations:------------ ------- - ---------------- ---------•----------------------------------- <br /> --------------- - ----------------------------------•-------------------------- ---- <br /> - -- ----------- ------------ <br /> ' ----------- -- <br /> i - <br /> ------------------------------------------- - <br /> ----------- --- -------- --------------------- ------- <br /> Date <br /> INSPECTION BY------------ - ?NJOAQU <br /> -- -------------------- <br /> 0S <br /> -------- - <br /> Date....-------( "-�__..SJ�.._._ -- ----------------------------- <br /> ,SIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Lodi,California Manteca,California Tracy,California <br /> Stockton,California <br /> I r.P.co. ' f <br />