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FOR OFFICE USE: a <br /> ce <br /> Permit No. ..--;-----•--•-----•- <br />--------------#�------ 0---------- ------ ------ APPLICATION FOR SANITATION PERMIT <br /> ---- --------------- - ----------------- ------ ---- - <br /> (complete-in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Sen Joaquin Local Health District for ai_permit # construct and tlRaorkry1hrerdescribed. <br /> + <br /> This application is made in compliance with County Ordinance No. 549. y <br /> JOB ADDRESS AND CATION.cc t-�-�- --p-.- <br /> ---------- <br /> Owner's Name - hone <br /> ---•------- <br /> ?7-� <br /> - ----------- P <br /> F �1 AAS -----•-----------•------- --- ------------------------------------------- <br /> Address - -------- <br /> zf <br /> .---•i Phone. <br /> Contractor's Name----- --1�.�'---- -- ------ ---------- -- �.----- <br /> ---------- ---••---- •-----•----------- <br /> Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..._-. Number of bedrooms -_-___._ Number of baths !_ Lot size ----- --- -------- -------- -------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan 12 Y <br /> Previous Application Made: (If yes,date----------_------- ) No ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ <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 nearest well ................Distance from foundation--------------------Material ........--_....._----------__--._-__-_-----_--. <br /> ❑ No. of compartments--------------------------Size-------------------- -----------Liquid depth.----- -- ------- ------- Capacity----------------� <br /> s f <br /> Dispos field: Distance from nearest welL._.✓�d__...._Distance from foundatio —.��----------Distance to nearest loft line----_5__..----. <br /> Number of lines-----------1--------------------Length of each line-- __-- -- m -------.Width of trench...y_----------------------•-- <br /> Type of filter material__._._ __.S.R�_...._Depth of filter material-.---4...-..__--.Total length-_-.--Sit_`____________________--•-- <br /> � S <br /> See paq�Pit: Distance to nearest well- .---lUg'__...___Distance from foundation-__.1C_. ____Distance to nearest lot line._______________ <br /> Number of pits--- ------e------Lining material-------- °--- Size: Diameter---_— .......Depth_. s- ------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation.....------------ ..Lining material------------------------------------- <br /> E-1 Size: Diameter- -- -------- ----- --- ------------Depth--------------- -------------/---------------------Liquid Capacity-------:----- -------------.gals. <br /> Privy: Distance from nearest well----------------------------------- ------- Distance from nearest building___.--.._____-----._._-_--lCount <br /> Distance tg�earest lot rine - ----------------T-------- <br /> Remodeling and/or repairing (describe)------ - --- ------------- ` --------------------------- -------------- <br /> ... ------------------------------------ <br /> -------------- <br /> r <br /> -------------------'------------- -----------------------------------•------------------------------ <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I Have prepared this application and that the work will be done in accordance with San Joaqui <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) -end/or Contractor) <br /> - -- - --- --- --- -(Title)---------- --------- - -- ------------ --------- <br /> (Plot plan, showing size of lot, location of system in lation to wells, buildings, etc., can be placed on reverse side). <br /> fOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ----- ---------------------------------------------- DATE----'/--~��-. fa✓v ----- ---------------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------- -----------------------------• DATE-------- ---•------- -------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- ------=--------------- ------ ------------------------------------------------------ DATE--------------------------- -- ----------------------------- <br /> Alterations and/or recommendations----------- --------------------- - -- ------------- --------------------------------------------------------••------------------------------- ---------------- <br /> ------------------------------------------ <br /> ------- ---------------------•---------- - -------I--------- ---- <br /> FINAL INSPECTION BY:... - _�`��'�'.-'lll�-- 'f�------•--._..._. <br /> -•---- Date-..y__ -------- -------- -- - - --- - -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> 1E.H.9 2M 1.67 Vanguard Press <br />