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FOR OFFICE USE:. <br /> --------------- -------------------------------- � <br /> APPLICATION FOR SANITATION PERMIT Permit No. . _. <br /> ----------------------------------- -- - ------------- (Complete in Duplicate) <br /> _�__��--�� <br /> ------------- --_----------_------------------_____._-. This permit Expires 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 install the work herein described. k <br /> This application is made in compliance with County Ordinance No. 549. t � <br /> JOB ADDRESS AND OCATION---- _7__.i---f�------= . ..... --•---- <br /> Owner's Nam •---- -- 1•`` u �-�� `f ^ �- Phone_ <br /> --•---------------•----------------------------------------------- <br /> c . <br /> Contractor's Name---- - f J z/1'f�- -----ti ------ --- ---------------- ------- Phone---------•-•-------hyo <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑/4�• R. <br /> Number of living units: j---- Number of bedrooms _tom'.._ Number of baths j----- Lot size ------/__4-�` —­----------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [9/Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ f <br /> Previous Application Made: {ff yes,date---------------- ---l No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> [No septic tank or cesspool permitted if public sewer is available within ZDD <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation------------------- Material----------------:--------------- ------_-__---.--'°"-�''"� <br /> ❑ No. of compartments----- ------Size------- ------Liquid depth---------- ---------------Capacity-------------------- s <br /> E ' i <br /> Disposa field: Distance from nearest well____:___-_._D stance from foundation__.-- ____..__Distance to nearest lot line--- <br /> Number of lines---------- ""�-_----_ ______Length of each line----_- -- --------- ----Width of trench._-_ `._._...___.._______._.. <br /> p n <br /> Type of filter material------- - _�. pi f <br /> ._De th of filter mater�al_____f_�___.__-_._Total length_-__-���___________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from .- <br /> foundation------------... ...Distance to nearest lot line----------------- <br /> [] Number of pits----------------------Lining material----------------------.Size: Diameter------------------..---Depth-------------------------------- <br /> Cesspool: Distance from nearest well-----------------.Distance from foundation-------------------Lining material---------- -----_______.___-.--_ <br /> [] Size: Diameter- -------=------- ----- Depth--------- - - ----------------------- --------------Liquid Capacity---------------------------.gals. <br /> Privy: Distance from nearest well------- ------------------------------- -----Distance from nearest building----------------._------__-_-__------...G 1 <br /> 1 <br /> ❑ Distance to nearest lot linnet -------------- ------------------------- ---------------------- ---------------------------------------------------------------------- <br /> Remodeling and/or repairing describe): �A�'�._ ` �'---"�---------- + r - ,4` - ' <br /> @---•-•---------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------•-----------••-------------•••------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------- -------- ----------------------------------------------------------------------------------------------------------------------------------------------------- <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> _.-_(Owrter and/or Contract <br /> (Signed) � -------------- '_ <br /> �-----------------------------------(Title)--------------------------------------- - -- - -----------.....' <br /> (Plot plan, showing size of lot, location of system in relationnells, buildings, etc., can be placed on reverse side). <br /> ` <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------------------- DATE ' ��� ... <br /> '..�- <br /> REVIEWEDBY-------------------------------------------- ------------ --------------------------------------------- ------------ ••- DATE.------- --------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ DATE----------------- <br /> Alterationsand/or recommendafions:------------------ ------ -------------------------I-------------------------------------------------------•------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------•----------------------------------------------- ---------------------------------------- --------------------------------- <br /> FI NAL INSPECTION BY:.,, tea " " -- --- ------ Date 7 Z7_ 7---- -------- ------------------- ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br />