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FOR OFFICE USE; - - -- <br /> - ... - --------- ---lam �. <br />--------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> p (Complete in Duplicate) <br />---------------------------------------------:............ This Permit-Expires 1 Year From Date Issued <br /> 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. S49. � i1r� <br /> JOB ADDRESS AND .LOCA N...__ �' <br /> Owner's Name------------ "l`"_ Phone `�1 61415/7 <br /> y 5 <br /> --------- ----- -- - ----------- --------- <br /> Address____..._ �. ------- <br /> - �£ . ... '6 .....-.... ---------------------- --_---._.-._. <br /> Contractors Name____________ _ <br /> -•---- •----• -------�---- --�---'--- -� - - •----------- Phone-- q <br /> Installation will serve: Residence ❑. lApa,rtmenT House ❑ Commercial ❑ Trailer Court ❑ Motel jx Other ❑ <br /> Number of living units: 1-2--_ Number of bedrooms (.S--_ Number of baths Lot size ------------------­_,k-_�-(7c- <br /> Water Supply: Public system ❑ Community system ❑ Private A Depth to Water Table jT_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------- ----) No X New Construction: Yes ❑ No X FHA/VA: Yes ❑ No X <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 newest 1__. _-_ ,,--_ istance from foundation-------------------Material-------------------------- _-_-__-------_-__. <br /> ❑ No. of compartment ize--------------------------------Liquid depth----------------- --------Capacity----------------------- <br /> d <br /> Disposal Field: Distance from nearest weft-.- _.__ istance from foundation--------------------Distance to nearest lot line---------------- <br /> ❑ Number of fines---- --- ---------- --- -- ength of each line-----------------------------.Width of trench----------------------------------- <br /> Type of filter materia________________________Depth of filter material-----------------------Total length-----------------__________--_-__ <br /> See a e Pit: Distance to nearest'well_ 1J_ _.�-___Distance from foundation____ _ c5' <br /> P g Q________.Dist ce to nearest lot line____ _ _________ <br /> �f Number of pits-----l--------------Lining material---jVd-Cllr---Size: Diameter___. Depth__- - F W <br /> Cesspool: Distance from nearest well___________ _Distance from foundation------------------- material______-____-_____-----_-_____.___.-_ <br /> ❑ Size: Diamefer--------------------------------------Depth-------------------------- --- ---------------------Liquid Capacity---------------------------9als., <br /> Privy: Distance from nearest weft____________________________________________ <br /> _____Distance from nearest building._____--__-__-___-_---_-____--_-_._.___ <br /> ❑ Distance to nearest lot line------------------------- ------------------------------ -------------- ------------------------------ t <br /> Remodeling and�c iepai 'ng (describe): 4 '�--- c- --- - 06 <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?Fegulations of the San Joaquin Local Health District. <br /> (Signed)_ ---------------------•-- -------.-- -(Owner and/or Contractor) <br /> By- cc -----------------------------(Title)------------------- -------- -------- ---- - : <br /> (Plot plan, showing size of lot, location oaf system relation to wells, buildings, etc., can be placed on reverse side). <br /> 1 OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ ------------------------------------------------------------------- DATE------ -- <br /> REVIEWED ,BY--------------------------- --- ---------- DATE------ -------- -- -- - <br /> BUILDING PERMIT ISSUED-------- -------------------------------------------------= ---------------- DATE.- - <br /> Alterationsand/or recommendations:-------------------------------------- --- -- - - -----------------------------------------------••---------...----------------•------------------------------- <br /> ---- x----- ------------•--------------------------------•------- <br /> -L.� -- ---------_------- ------------ -------------------------------------------------------- -- - ---------------------------------- <br /> -----•------------------------/----------------- - r ---------------------------- -------------- ---------- -------------------- --------------------------------------------------------------------------- <br /> ------ ----- ------------------------------ - -- -- - --------------------- ------------------- --- --------- ­------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:....----- ---- -- - -------------- -- ------- --------- Date------.- 4 6 - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California <br /> + Lodi,California Manteca,California Tracy,California <br /> X <br />