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FOR OFFICE USE: <br /> s.----------- �� � ii <br /> -------------------- ------------ ------- <br /> APPLICATION FOR SANITATION PERMIT Permit N../ ..¢��_l..._ <br /> (Complete in DuplicaQe)•»7- f 1 <br /> r,' Date Issued / --/--------5 <br /> -,-_-_----------------r--____ _- ______.__..-____.__. 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,E t <br /> JOB ADDRESS AND LOCATION_._�.�I__ -� '- - ----------------------------------------------------------­------------------------- <br /> Owner's Name---r----7 ------•--------------------------- ---- ----------------------------- -------------- Phone.... ------------- •-------•--- <br /> Address-- <br /> ddress_ . Arlie—-•-•--•-------- ---- - - - - - - -- ------ --------------------------------------------------------- ••-------------------•-••------------ <br /> - <br /> Contractor's Name---------- ---------------- ------------------------------------------------ Phone::•__.a.: '=-------- <br /> Installation will serve: Residence 23- Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ <br /> Number-of living units: __/___ Number of bedrooms __Z Number of baths Lot size ------------------------ <br /> I-V <br /> Water Supply: kPublic system community system ❑ Private U Depth to Water Table Aoft. , <br /> Character of.soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El :Clay❑= Adobe ©Hardpan ❑ � <br /> Previous Application Made: (If yes,date--------------------) No Rr' New Construction: Yes ❑ ` No � FHA/VA: Yes ❑ No <br /> T <br /> TYPE OF INSTALLATION,AND SPECIFICATIONS. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic k:" Distance from nearest well_________________Distance from foundation_____--________-_-Material-------------------------..-___------.----------- <br /> fNo. of *ompartmenfs---- - -------------- ---Size--------------------- --:---Liquid depth--------------------------Capacity-••------------- ------ <br /> Disposa Fiel Distance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line----------------- <br /> 1 Number of lines-------------- ---- ------Length of each line-----------------------------Width of trench----------------------------------- 1 <br /> Type of filter material ____________------ •:Depth of filter material_---------------------Total length_------------_-______________-_____-_ <br /> I` Seepage Pit: Distance to nearest well_-_'--------------Distaneom foundation_:6p------------Distance to nearest lot line_4i:-__-____-_ <br /> Number of pits--/--------- ----Lining material-___1 ----'Size: Diameter----3-3-.E----_--Depth-i�----------------- <br /> I <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---:--------------- Lining material----------------- ____-________Size: Diameter--------------------------- --------Depth-----------------=------------- - ---------------.-Liquid Ca pacify- - . -gals. <br /> Privy: Distance from nearest well____________________ __----____---.__-_.------_Distance from nearest.building____---___.-__________________--__------- <br /> ❑ Distance to nearest lot line-------------- ____' -- <br /> Remodeling and/or repairing (describe):------ -__. -------------t-- �r ~. <br /> f <br /> -----------------------------------__-____._____________________--______--_____--__ <br /> ---------- <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)_ __ * --�-- (Owner and/or Contractor) <br /> r - <br /> Title---------------------------- ---------- .--------------- <br /> BY: ---- ------------------------------- ---- ----------------------------- etc., can be on reverse side---------- ---{ ). <br /> F -[Plot plan, showing size of lot, location of system in relation to wells, buildings, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------------------------------------------------------- DATE-------I� - _ ------- <br /> REVIEWEDBY-=-------- =- ----------=----------------`- ------------------ DATE----------------- ------------------------- ---------------- <br /> BUILDINGPERMIT ISSUED----------•------------ ----- -- --- ------------------------------- -- ------------ ---- ---------------------------------------------- <br /> Alterations ---and/or recommendation3: --------------------------------------------------------------------------- <br /> � -------------------------------- <br /> ' - - ----------------------- <br /> -------------- ------------------ ------.------•------ ------ ------------------------------------------------------.------------------------------------------------------------------------------ -------- <br /> ---------------------------------- <br /> ' =-----•------------ ------------------------------------------- ------ <br /> FINAL INSPECtIOWBY-- - - ------ ----- ------------------------- µ' Date------------ �l1 -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />