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F R QFFICE USE: <br /> '----------------- <br /> --- - ------ --- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . .._.__..J.. <br /> ------------------------------------------��---`—��'- (Complete in Duplicate) �/ / <br /> ------------------------------------------ -.. This Permit Expires I Year From Date Issued Date Issued ._.-__L__�_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and inst the work herein described. <br /> This application is made in compliance with County Ordinance o. 5 9. <br /> JOB ADDRESS AND L N C�f f- ------ ---- - - --- -- --- ------ ---- - ---------------------------------- <br /> Owner's Name----------au------ -- - -- ------- - - -------------------------- Phonel = <br /> Address -- ---- ----- <br /> Contractor's Nell <br /> a t -_; <br /> t Phone <br /> Installation will serve: Residence partment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ... .. er of bedrooms .. Number of baths __�... Lot size ..'. _ ' <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .6-Oft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ze Hardpan ❑ <br /> Previous Application Made: (If yes,date--------...---------) No ❑ New Construction: Yes ❑ No Wl-�_F'HA/VA: Yes ❑ 'No ❑ <br /> TYPE OF, INSTALLATION AND SPECIFICATIONS: <br /> AINo <br /> septic tank or cesspool permitted if public sewer is available within 20 .0.feet.) <br /> .i Distance from nearest well_____---------_Distance from foundation--------------------Material.... <br /> p q R Capacity-- <br /> No. of com artmenfs------ - ---------------Size------------------ --_ --:-..Li uid de th.._---__ ---- ----------- <br /> s r Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line_-_____-..-._-_-. <br /> Number of lines--------------------_.---- Length of each line-----------------------------Width of trench------ .. .___ <br /> Type of fifter material................._.__.._Depth of filter material------------------- length-----_-.._1'�_L __.._ �*,27 JJ <br /> Seeae Pit: Distance to nearest well__ __ _0-9-____Distance from oundation__/�___.Distance o nearest lot]�line.------ � f <br /> f` Number of pits---l__.--------------Lining materia!_ C. -------Size: Diameter.. - Depth.._ .......-- I <br /> s •- <br /> Cesspool: Distance from nearest well- .-----Distance from foundation <br /> ------- ___----___Lining material------------------------------------- <br /> ❑ Size: Diameter--------------------- ----------------Depth-;-------------------------- -------- t-----------Liquid Capacity-- -------------------- -gals. <br /> Privy: Distance from;nearest well___________________._I-___-----.-:.._..........Distance from nearest building-----_----------------------------------- VIP <br /> ❑ * ; Distance to nearest lot line---------------------------- ----- - - -----r- ----------------- I----------------- <br /> Remodelingand/or�rR iring (describe)=-- ------ ------------ -------------- -------- -------------------------------------- --------- ----------------"--------------------•-------- ---------•r'1 r <br /> ------------------ ------------------------------------• •----------------------------------•---------------- ------------------ r <br /> - ----------------- ------------------ --------- ---------------- -------- <br /> -------------------------------------------------------------=------------------- <br /> IL I <br /> ----------------------------------------------------------------------------------------••--i------------- --- ----- --- --- -------------- - d <br /> I hereby certify that I have prepared this application at a work wilf'be done i ccordance with San Joaquin County <br /> ordinances, St e s d rules' and'rg1lati s-of the San Joaq in cal Health strict.. <br /> (Signed} .�• - - --------------------- - ----�r Contractor) <br /> B ----------- Ti+le------- ..._ ---------- ` <br /> Y:------------- --- - -- - } ) ,t <br /> (Plot plan, showing size of lot, location of system-in relation wells, buildings tc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- - = DATE..* �' I <br /> REVIEWEDBY--------------------------------------------- -------------------- --------------------------------------------------------- DATE---- --- ------------------------------ ---------------- <br /> BUILDINGPERMIT ISSUED---------------------------------- ----- ----------- • -••--------------------------------------- DATE--------- -------------------- ------------------------------ � <br /> Alterations and/or recommend citions:-----------------------------------------------------------------------:......1,­---------- -------------------------------•-------------------------------- <br /> �1 = [ " A -- -------------------- -----------------`-------------------------- ----------------------------------------------------- <br /> -------------- -- - ------- ................ --------------------------- -- --- - ------------------------------------------------------------------------------•-- - ------------------------------- --- ---------------- <br /> FINAL INSPECTION BY:..... ------ _.---_____-- _ -- lo- 6i <br /> ----------- ------• Date---.-?- --------------- ------ -------- --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycarnore Street .205 West 9Th Street <br /> Stockton,California Ladir California Manteca,Cif rnia Tracy,California <br /> _qjF.P.00. `�- <br />