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FOR OFFICE USE: <br /> -------------------------------------------------------- +�- J".. •ti <br /> a ---------------- -------_._ ---....__.-__. APPLICATION FOR SANITATION PERMIT Permit No. - 5-�� <br /> --- --- ------------------ --- ------------------ -- j (Complete in Duplicate <br /> -- --- This Permit Expires 1 Year From Date Issued bate 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 /> JOB ADDRESS AND LOCATION__'_c _ ___`_.3________ C�/jG. <br /> Owner's Name----- "GP # �► d`. —--------------- Phone <br /> ----------- ----------------------------- <br /> Address 9Yr< G �i /� `*7�c • <br /> Contractor's Name--------- ---- 1- r�r� - S �".t h2. �b__/ ._. oe. Phone__.. "r ".1 <br />! i <br /> •--- <br /> Installation will serve: Residence ©^ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel'❑ Other ❑ <br /> Number of living units: __f__ Number of bedrooms _410L' Number of baths _Z Lot size _-__-_ _.._ ------------------- <br /> ---------- <br /> Water Supply: Public system ❑ Community system El id Private g- Depth to Water Table _S'0"ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ • GFavel ❑ Sandy Loam ❑ Clay Loam ®--Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date....._____ -------) No.®-- New Construction: Yes F�- No ❑ FHA/VA: Yes IRO' No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t l <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.), # t <br /> I E y elf <br /> Septic Tank: Distance from nearest we11.__± o_..____Distance from foundation_`_40''_--------Material__. C_A-_�2-/ <br /> No. of compartments----„Z, ---- ---------- - -yf�K -----Liquid depth---'--- `f------------Capacity____?_!t�s `�' <br /> Disposal Field: Distance from nearest well-_5"9-------Distance from foundaf-ork_ Q r -Distance to.nearest lot line___f.----- c <br /> [�— Number of lines!------ Depth of filter mater!al__ id of trench___!t_.�_....__ . _ <br /> g : °'` <br /> u2__ ___________'Len th of each lin _:_ <br /> f< ` ` <br /> .Type of filter maerial-----�_Q_c_�---- �'_s$--------------Total len gth__---------- <br /> Seepag it: Distance to nearest well ___Z/$__r__-_:_Distance from fou dation-- -------------- Distance to nearest lot line___ L•�[ <br /> Number of its__i. .s�_ -Size: Diameter__ De th_Z <br /> pits--'., Lining material _ _r p <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-,__..._._.------. Lining material.__.---___._____-_.---____ <br /> F1Size. Diameter. ~�_✓ . <br /> --- ----Depth-------------- ----------- ---------- ---- - ----Liquid,Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------------- ---- ..._-_.._.__...Distance from nearest building---------------------------------- <br /> ❑ Distance to nearest lot line----------- <br /> Remodeling <br /> ------ -Remodeling and/or repairing (describe)------------------------------------------------------------------------------- <br />' I ✓ <br /> T ------------------------------------------------------- -------------------------------------------------------------------------------••--------------------- ----------------------------------------------------- <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) ------------------------- --------------------------- ----- <br /> ------------------------- -------(Owner and/o ontractor <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 /> l <br /> FOR DEPARTMENT USE ONLY <br /> 9 <br /> APPLICATION ACCEPTED BY ,. --------------------------------------- DATE-- <br /> REVIEWEDBY----------------------------------------- ------------------------------------ ------------------------- -------------•--- DATE------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------- ------ --------------------------------------------- DATE <br /> ----------------------------- <br /> Alterations and/or recommendations------------------- --- -------------------------------------------------------------- --------------------- <br /> r <br /> ---------------------------------- <br /> ---------- ------------------------------------•------- ---•--------- ---------- --------------------------------------------------------------------------------------------- ------------------------------------- <br /> ­ I <br /> •------------------ ---------------------------------•------------------------------------- ----------------------------------- <br /> ---•----------- ------------------ ------------------------------ -- <br /> F1NAL INSPECTION BY:...7_ .4flllf� ---------- Date-----//--.._�. T__ -6-- - <br /> f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br /> F i7 <br />