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FOR OFFICE USE: <br /> ------------------------ <br /> ----- --- ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------------------------------------------- (Complete in Duplicate) Date Issued ---10Z <br /> ---------------------------------------------------------- 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 f work erei e ribed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AACCAT <br /> Owner's Name ------ <br /> ------ -------------------------------- - ------ --- - ------ ---------------- --------2------------ <br /> Address ---- —- ---- -----------..... <br /> Contractor's Name------ = ----------------••-=--------------------------------------------------------------------._. Phone----------------------------------- <br /> Installation will serve: Residence g?"-Apartment House E] Commercial E] Trailer Court [] Motel [] Other ❑ <br /> 0 Lot size <br /> Number of living units. Number of bedrooms --//- Number of baths ----------------------------- <br /> Wafer Supply: Public system ❑ Community system [71 Private �Depth to Wafer Table 447f' <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam [Clay Loam 0 Clay L] Adobe [3 Hardpan F] <br /> Previous Application Made: (If yes,date ----------;--- ---) No Zr New Construction: Yes Ej No Uq---�HA/VA: Yes ❑ No R4-1` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T-ank;,, Distance from nearest well--..__---.___---Distance from foundation-------------------Material_----_----.-_---._..-----------____.__------._. <br /> No. of compartments------- ------.-,-Size--------------------------------Liquid depth--------------------------Capacity--•---A------ <br /> lepIr$)41* ---------- <br /> Disposal,ReU, Distance from nearest well___--- --Distance from foundation_ ---------Distance to nearest lot line._.____..______ <br /> Number <br /> ine.--- --------- <br /> Number of lines_______ Length of each line__1_-;111__/---------------Width of french-.Z-- <br /> -___,.__Total length_,_A�,__ <br /> V Type of filter mate rial/4, Depth of fifer material_. -------- -:--__-------------------- <br /> ti <br /> Seepage Pit: Distance to nearest well--/'P ------ <br /> Distance fr-Qm foundation___ __a _____ Distance to nearest lot line_ ------ <br /> Number of pits----- ---...Lining material-_/_& e/e_-Size: Diameter__! . ---------- Dept h_a?4t <br /> 'Ces'spool: Distance from nearest well-----------------Distance from foundation--- -----------------Lining material---- -------------------------- <br /> El -r- Size: Mameter------- ------------------------------Depth------ ----------------------------------- <br /> ----------Liquid Capacity- --------------------------gals. <br /> -Privy: Distance from nearest well--------------------------------------- ---------Distance from nearest building.._.______.__ _._-______-_-__----__-. "1 <br /> ❑ <br /> uilding---------- -- ------------------------- <br /> ElYDistance to nearest lot line------------------------- ---- - --------------------------------------------- - ---------------- -------"I------------OF <br /> t <br /> Remodeling and/or repairing (describe):--------------- .............................. <br /> --------------------------------------------------- <br /> ?41 -1-0-,�_ ,-___'.-, <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - <br /> - I---------------------:-- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - <br /> - ------- <br /> ---------------- --------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ------------------------------ <br /> ­------- <br /> y <br /> 1 hereb 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 ru <br /> ks and regulatiops of the San Joaquin Local Health District. <br /> • t <br /> (Signed)+---------------- <br /> --------------------; ... ---------------------------------------(9-1---------— Contractor) <br /> By:-------------------------------------------------------------- ------- ---------- <br /> (Plot plan. showing size of lot, location of system in rel on to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY, <br /> _'- - . ---- -q;—­_(a---5-- ----------------- <br /> APPLICATION ACCEPTED BY-------------I-------------------------------------------- ------------(_- _K_P�ATE----------- ­6 _ ------- <br /> REVIEWEDBY------------------------------ - -- -- ----- ---------- ---------- --- - ------- -1-- ----- -------------- DATE.-.----- --------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------- ----------------------­----------------------------- ------------------------- DATE------- <br /> Alterations apd/or recornmencIati2ns:------- 0/ f� ...... e_1__1------ <br /> r­�� -- ------------------ ------------------- <br /> --------------- <br /> ------------- -Y <br /> ----------�7 <br /> - -------------- ----------- -- ----------- --------- - --------- ---- <br /> 'FINAL_INSPECTT1N BY:-- Date------ <br /> ------------ --------- ------ ---- - ----------------------------- <br /> Ar----- - ------------ A10 <br /> 5�1 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca, California Tracy,California <br /> _4 <br />