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FOR OFFICE USE. 77. <br /> ell <br /> -------------------------------------- <br />------,------------------­-------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._.;. .............. <br /> --------------------------------------- --------------- (Complete in Duplicate) JJ <br /> --------------------------------------------------------- This Permit Expires I Year From Date Issued 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..... > A <br /> J - ------/ -1 ...I................................................... .................. <br /> . ........ ....... <br /> --------------------------------- <br /> Owner's Name <br /> ------ Phbne. /0__ <br /> Address ' ---------- <br /> ._..- ­-------- ----------------- ------------------------------------------------------------ <br /> Contractor" <br /> Ar <br /> Installation will serve: Residence's <br /> Apartment House E] Commercial [I Trailer Court (3 Motel ❑ Other [3 <br /> Number of,living units: _1... Number of bedrooms 3--- Number of baths /----- Lot size ...................... <br /> Water Supply: Public system ❑ Community system [I Private' Depth to Water jjble,60__ ft. <br />—'CW-ar-a-dfi_r a'soilLc�am Clay Loam E] Clay [3 Adobe[] Hardpan C]� <br /> Previous Application Made: (if yes,date___________________}/No E Now Construction: Yes E] No [] FHA/VA: Yes [3 No [0] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS; <br /> (No s6ptic tank or cesspool permitted if pu6lic sewer is available within 200 feet.) <br /> .Septic Tank: Distance from nearest well_-L-.-------------Distance from foundation---------------__Material................................................. <br /> ❑ No. of compartments------"-.,/--------------Size---------------------------I...Liquid depth--------------------------Capacity....................... <br /> Disposal Field: Distance from nearesf,411l 0 Distance from foundation____...._. Distance to nearest of line................. <br /> Number,of __ LL gth of each line------574?---------------Width of trench___X—----------------------- <br /> Type of filter material__ pth of filter length- .......................... <br /> Seepage Pit: Distance to nearest well----_--------------- Distance from foundation...............-_.Distance to nearest lot line___________.___-- <br /> Number of pits............. -------Lining material......-_------------Size: Diameter____....._____-- ---------.Depth--------- ........... ------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------__Lining material------------------------------------- <br /> "ter. <br /> Size: Dia��nb -------------------------------------Depth----------------------------------------------------Liquid Capacity---------------_--------_gals." <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___________.........._ .... <br /> ❑ Distance to nearest lot line-----------------------------------------------' = <br /> Remodeling <br /> ine------------------------------------------------ <br /> Remode1ingand/or <br /> or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> .................... ................. ----------------------------------*-----------------------------------------------------------------------------------------------------------*------------ <br /> --------------- ----------------------1- <br /> ------------------------------------------------­---------------------------------*------------------------------------------­----------------------------- <br /> ------•---•-•-•-- =--------------------I--------------------------------------........-------------------------------------------------------------------------_­..................I.......I-------------------------- -- <br /> I herebyify that,I have pr4pared this application and that the work will be done in accordance with San Joaquin County <br /> e <br /> j <br /> rule <br /> ordinances, talaws�, d r u he anap7julations of the San Joaquin Local Health District. <br /> le <br /> ------ ---------------------------(Owner and/or Contractor) <br /> Signed)------- <br /> � -1----------------- ------------------------ <br /> By:......................114 1 <br /> ............................ ----_------------7 ---------------(Title]_....------------------ ---•--••--------------------------- ' <br /> (Plot plan, showing size of lot, locafion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT.USE ONLY <br /> APPLICATION ACCEPTED BY-------__7..__t. ------------ ------------------------------- -------- ----------------- <br /> REVIEWED BY--------------- if I <br /> ---- -----------------------------------------------------------------------------------­-------------------- DATE-------' <br /> BUILDING PERMIT ISSUED--------------------------------------------I-------------------------------------------------------- DATE_.-.------------------------------ <br /> Alterations and/or recommenctaflons---------------- ------------------------------------------------------------------*--------------------------------------------- <br /> 3 r <br /> ---------------------------------- -------------------------- -------------------------------------- ------------------------------------------------.......................... --------------- <br /> .............. <br /> ..............................--------------------------------I------ -------------------- ---------------------------------------------I------------------------------------------------------------------------------- <br /> ............ /17 /--"\ <br /> ----------------- -------- ------- ....:-------- -----------• ---------------------------------------------------------------------------------------------- <br /> ----------------........... -------- ....... ------------- <br /> ------ --- ----------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECL -_ --- ---------voyao;17 Date----------- <br /> - --------- .... . .. - ------ -- --------- ----------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 13.0 South American Street 300 West Oak Stiew 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Es 9 REvism 9-59 YM S-61 ATLAS <br />