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,'FOR OFFICE USE: <br /> -------------- ------------ ---------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. -.Lfn4.a-_ <br /> -- ------------- ------------------- -------- ----- - (Complete in Duplicate) <br /> - Date Issued <br /> --- -- --------.-----------------------_--- ------------ I 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 the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS LOC(A�T,I�OU � ----- --- --- <br /> Owner's Name -d l{ ------------------• ---------------------- -- ----------------------------- ------ Phone-------------- -------------- <br /> Address__,'--------- <br /> ---- ---------Address_-___..___. __.. <br /> ---------- ' ----------------- = -----------------------------------.--•--------------------------_------------ <br /> I <br /> Contractor's Name--- .......... •--------•- --- Phone............ <br /> .. <br /> t <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 ❑ <br /> Previous Application Made: (If yes,date--------------------) No F1 ..New-Construction: Yes ❑ No E] FHA/VA: Ye's ElNo E] <br /> r <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> # (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ! <br /> Septic <br /> Tank: Distance twell---------- ----Dance from foundation-------------------.Material------------------------ •------------------ <br /> Noof compartments - TeLiquid depth--------------------------Capacity----------------------- <br /> Disposal <br /> --------__----_---- -•Disposal <br /> Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- <br /> 'El Number of lines----- -----------------------------Length of each line-----------------------•------Width of french-------------- •------------ ---- <br /> Type of,filter material---------------- ------Depth of filter material------------------------Total length-------------------------------.---------- <br /> pW-ge Distance.to nea-reO well----- S------_--Distance f foundation---ED____.____.DiAance to nearest lot line <br /> �------ -----Lining material---- ---Depth------ _1A-f---_-_-�---d---_-.-.-.-.-- <br /> -❑ Number of pits''-'_ ------ r <br /> 7X� - <br /> i <br /> Cesspool: Distance from nearest well-------' _-_.-Distance from foundation--------------------Lining materia ------------ <br /> ❑ Size: Diameter------------------------------- -'---Depth.------------- ------------------- - --------------Liquid Capacity----------------------------gals. <br /> ti <br /> Privy: - Distance from nearest well--------------------------------------------,{F_Distance from nearest building__--------:____.--_--__-------.._..__..._. <br /> ❑ Distance to nearest lot line - --- --------------- ---------f'-----------------••---------------------------------------------------------------------------- <br /> ---- -------"-.", ----------------------------------------- -•-------------•---•-----------------------------------• 1 <br /> Remodeling and/or repairing (descr.i�e�:_""""- `- ._..___"�'�"`-" <br /> ` ----•-•-•--•-------------------------------- --- - ---- ---------------- f <br /> t <br /> ----------------------- <br /> } _: - -- _: <br /> - ------- = -------- ---------------=- - - ----------------.­ --------------------------------------------------1 .4 <br /> "j <br /> I-"hereby certify that I.have prepared this,application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State Iandd rules and regulations of the San Joaquin Local Health District. hSi ned --`--- ---- ---- ------ --� r-------------`=-----=--------------------------------------------- end/or Contractor) <br /> By:---------- --- �:-t----- = = (Title) <br /> (Plot plan, showing size of,,lot, location of system in relation,to w s, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ^- .---- ------------ --------------------------------------- DATE-_ b__f "_ --------------------------- <br /> REVIEWEDBY----------------------------------------------------------------------- ----------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------------- <br /> Alte'rations and/or recommendations:-------- ----- ------------------ - ------••-----------•---------------------- --------••-•-•----------------------------------------------------- <br /> ` ---- -----•----------------------------------------------------------------•------------------------------------ ------------------ <br /> { ----- —-------------------------•--------------------•-- -------------------------------------------- <br /> t <br /> ---------- - --------------------------------------------------------- <br /> --------------------------------------------------------- ------------------------------------------------------- <br /> FINAL INSPECTION BY./. ,102.04... .- -_t -.- <br /> --- -------- Date__ d__ _ ----.--------------+-w-------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 31A 3-'63 r.p.ca. <br /> i <br />