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APPLICATION FOR SANITATION PERMIT <br /> Permit No. ......... <br /> ----- ------------- <br /> (Complete in Duplicate) <br /> --------------- -- ------ ----------- ------- ----------- This Permit ExIoires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 101 ADDRESS ANILOCATION--- <br /> .......... <br /> Owner's Name__._ ------------------------------------------------------------------------- <br /> Address--------------- - --------- ------------------------­= Phone----------------------------------- <br /> - <br /> --------------------­------------------ <br /> Contractor's Name.----- -.--- <br /> ------ Ph on e,440I.., <br /> Installation will serve: Residence El Apartment House [ Commercial El Trailer Court ------- <br /> Motel E] Other El <br /> Number of living units: //-- Number of bedrooms _4 Number of baths "Lot size'... 7 <br /> -----V�.7----------------- <br /> Water Supply: Public sysfem E3 Community system [:] Private " Depth to Water Table.,��t. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel [] SandY Loam E] Clay Loam"El Clay 0 Adobe 9W Hardpan <br /> ❑ <br /> Previous Application Made: (if yes,date--------------------) No [V New Conifrucf;on: Yes,' No El FHA/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____,SCT -Distance from foundafion_fes_" M teriai__ <br /> xNo. of compartments.__._%? -------------- <br /> A --------------Ca pa city__;7;�Fq45;f1e- <br /> ------------Size---02,KSW _-Liquid depth_- <br /> Disposal Field. Distance from nearest Distance from founclation.AZ_------ Distance to nearest ]of line--%S <br /> Number of lines-------_S---------------------Lengfh of each ...... Width of t,ench_.Iz;7, - -1-- ---------- ----- <br /> Type of filter material-_000G?---------Depfh of filter rnaferial--XR.'�..........Total length--- --------/ <br /> Seepage Pit: Distance to nearest well__AC7i7__'__Disfance frm f n a t; <br /> .9cd ion_ _" <br /> o --------Distance to nearest lot <br /> Number of pits--..1455---- -------Lining material___Aero'C-Oe _..Size: Diameter__,_,?.3_.e ---------\n <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining-material-___.__..._-.___.__..___-------------------- <br /> ❑ Size. Diameter --------------------------- <br /> Privy: Distance from nearest we.I-I --Depth------ Liquid Capacity-.-,,.----------------------gals, <br /> El Distance to nearest lot line.__....____________________ -Distance from nearest building------------------------------------------\Y) <br /> ----------- ------------------------------------------ - ------------- <br /> ---------------- -------- <br /> Remodeling and/or repairing (describe):---------------------- -- ------- <br /> --------------------------------------- <br /> ----------­----------------------------------------------------------- ------------------------------------- -------------------------------------------------------- <br /> ------------------------------------------------- -------------------------------------------------- - -------------------------- <br /> ------------------------------------- --------------------------------------------------- <br /> ---------- <br /> --------------------------------------------------------------------------------------------------------------------- ----------- <br /> I hereby certify that I have pr -------------------------------------------------------------------------------------- ��this application and that the work will be done in accordance with San Joaquin'_'Ccunfy­_ <br /> ordinances, State laws, and rules and.regulations of the San Joaquin Local Health District. <br /> (Signed)--------------------------------------------------------------------------- <br /> r actor) <br /> By:----------Acf ------------ -----(Owne and/or Contractor) <br /> ---------------- <br /> - ----- ---- -- - - ---- ---- --- <br /> (Plot plan, showing size of lot, location --- wells, buildings, etc., can be pla-ced-on-'re've-rse--sid"e)--- ----- ------------- <br /> FOR DEPARTMENT <br /> APPLICATION ACCEPTED BY___________________ <br /> REVIEWED BY - -------- ---------------------------------------------------------- DATE------- >l _ -- <br /> REVIEWED <br /> ------------------------ ------------------------ ----------------------------- DATE <br /> BUILDING PERMIT ISSUED----------------------------------- ------------------------------------------------------------------ •DATE------ ----- ............. <br /> Alterations and/or recommendations-- ------------------------------------------------------- <br /> ----------------------------------------------------------------------Lo---------------*-------------------- <br /> ------------- --- ------- �------------- <br /> -1 L <br /> ---------- (071 C___ <br /> ----------- - - -------------------------------------- <br /> -------------ILI_ <br /> ---- --------------------- C_j I e <br /> ----------- ­5z�----------------------- --------------------------------- --- ------------- <br /> -----------------------------__-------- ---------------------------- - ------------- ---------- --------------- --------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:...___. "(- ---------------- 41' <br /> Date---------- --------- --------- ... <br /> ---- ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy, California <br /> F.Rr.a: <br />