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FOROFFICE USE: <br /> �. <br /> ------------ ------ <br /> ----------- '��------------i/,­-------- - APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------=----- .......... -------- ----------- (Complefe•in Duplicate) <br /> -'-------------- ---- --------- This Permit Expires 1 Year From Date Issued Date Issued ------ ----------- <br /> ? <br /> ---- <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 /> - ----- = `/------ .6 ---------------------------- - ----- <br /> JOB ADDRESS AND LOCATION--------------Tl -- - <br /> .. --------------- ---------- <br /> Owner's Name------- --------. . / __ / a <br /> -�- -f- -...1��..�_._•:_�/ -------- Phone-•---------••------------------•- - <br /> Address---------•- .g... <br /> Contractor's Name ,/ p ------ ---------- ------ Phone----- <br /> installation will serve: Residence E'-`Apartment House ❑ Commercial Trailer Court <br /> ❑ ❑ Motel ❑ Other ❑ <br /> Number of living units: __ .- Number of bedrooms�-_._ Number of baths.-2__- Lot sizee <br /> ----------------- <br /> Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table6l/- ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Graver❑ . Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ <br /> Previous Application Made: (If yes,date--........... ..... ) No New Construction: Yes ❑ No P— 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 /> Se tic Tank:. Distance from nearest well__------------._-Distance from foundation__------------__-__-Materiaf ........ <br /> No. of compartments------------- - ------Size-------------------- - -----Liquid depth.-- - Capacity----------------------- <br /> DisposalVi <br /> Fielder Distance from nearest well.__-�-'.-_Distance from foundation-�,�� � � <br /> �__..._.._-Distance to nearest I line �� <br /> '�$ Number of lines---------- <br /> Length of each line_.._1 -- -------.Width of trench_.--- <br /> Type of filter material Depth of filter material_.��--___- <br /> __.Total length..... <br /> to <br /> from <br /> Slag�alr(rr� <br /> Number of of pits res ell------_.Lining maDteraalCe fdS znDier - /� to <br /> nearest <br /> #'rline__ <br /> ssPo��� p --- <br /> o3: Distance from neares# well --Distance from foundation... .._------__-. -.Lining material---Diameter- -- --------- ----- -------- ---.--Depth.------------- --------------- - ------- -------..Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well---------------- -------------- ------------- -Distance from nearest buildingi <br /> ❑ Distance to nearest lot line-------------- ---- - -- -------------- - <br /> Remodelin and/or repairing describe :_..._--_ f r� <br /> - --------------------------------- <br /> ----------•------ ----------------........- <br /> ------------- -----------------------------------------------­­- -------------------------•----------------------------------------------------------------------------------------------------------------- <br /> 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 reg�iulations of <br /> the San Joaquin Local Health District. <br /> (Signed! ------ �� "^/- - L... __`^ <br /> ------------- Contractor <br /> ay:. ------ .ter" - (Tit <br /> (Plot plan, showing size of lot, location ystem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DE RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY'._ ---------- _-- -._ DATE._-3 e 6 <br /> ---------------------- -- ----------------------- <br /> ------------------------------------------- <br /> ---------------- <br /> BUILDING <br /> -------------------------- <br /> EVIEWED BY ---------------- ------------- ---------- <br /> - -- ----- ---- - ----. DATE--- <br /> ------------------------------------------ ------------ - <br /> - -------------------------------------------------------- <br /> UILDING PERMIT ISSUED - -------- DATE--------------------------------- <br /> Alterations and/or recommendafiions:....,.,5_':�--,S-:.GG��_--- --------- --- ------ --- �- --- <br /> . � <br /> ----------------------------- <br /> FINAL INSPECTION BY---,4-4 -------------------- Date--- ]�p----------- -------------- <br /> --- ---Ga <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave.' 300 West oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />