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�- -= A <br /> i 4k <br /> - APPLICATION FOR SANITATION PERMIT <br /> Permit No. ..A ........... <br /> (Complete in Duplicate) Date Issued <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 the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB -ADDRESS AND LOCATION ____ ____ ------/-----� -------� <br /> ---------- -------------------••------ <br /> Owner's Name I42 <br /> Phone------------------------------------ <br /> -- <br /> Address------------- <br /> -'' -46-0-- ------------ ------ ------ <br /> ��.. Contractor's Name--------------I'------= - -----------------------------------------------------------,------. Phone--------•-----------••------------- <br /> '0 Apartment House E] Commercial ❑ Trailer Court [I Motel (I Other (�I <br /> Installation will serve: Residence <br /> r ^ <br /> Number of living units: __I--'- Number of bedrooms ---I--- Number of baths ---R___ Lot size <br /> y ------- <br /> 'Water Supply: Public system ❑ Community system tj Private [Depth to Water Table __-K ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application MadeP Yes ❑ No ❑ New Construction: Yes ❑ r No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION jiAND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> p stance from foundation-------------------.Material <br /> ------------------------------------------------- <br /> No. c,0com artments_._._._`______________f5iz .Capacity----------------------- <br /> Disposal <br /> _____ <br /> --------- <br /> Septic Tank: Distance from nearest well----------------Dl e------••----------------- --=---Ligwd depth----------- ----------- -------- -------- <br /> Disposal Field: Distance from nearest weiL__________--_._.Distance from foundation____________________Distance to nearest lot ine___.____..__.___. <br /> ❑ Number of lines---------------- ------------------Length of each line----------------•-------------Width of trench------------------------------------ <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ ,- <br /> II <br /> Seepage Pit: Distance to nearest well---------____________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> ❑ Number of pits----------------------Lining material----------------------.Size: Diameter----•------------- ----Depth--------------------------------- <br /> r <br /> F Cesspool: Distance from nearest�well.D..Q_-____--Distance fromzfoundatioQ-.'7 ,..-Lining material gals.----------Liquid Capacity--.r4Y______---gals. <br /> 20 Size: Diameter_Pt�_�2_�-�a-- ----------Depth---------��------ ---------- -------- <br /> Privy: Distance from nearest well_____________________________________.__._.___Distance from nearest building_____---____________-.------------- <br /> ------------- <br /> Distance <br /> ___________--a <br /> 3 ❑ ______________________ <br /> Distance to nearest lot line-- ----- --------------- ---•---------------------------------------------------------------- <br /> 11 <br /> ------ -------------- --------------------- <br /> repel11mg `tea ------------------ -----_--------------- --------------- <br /> II .. _____________________________________________________________________________- <br /> ------------------------------------------- <br /> ____________________________________________I•---------------------_____..-------------------------------------------------------------------------------------------------------------________ <br /> ! herebJ'fa <br /> tify the} ----•----------------•----------------------- <br /> ---------------- <br /> ! <br /> have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, laws, ari�d rules and regula ions of the San Joaquin Local Health District. <br /> ner and/or Co <br /> (Signed) - (� .. <br /> w d o Contractor) <br /> a- <br /> - <br /> Tale l T <br /> in relation to wells, etc., can be placed on reverse side). <br /> r (Plot plan, showing size of.lot, location of system <br /> FOIt;D>:P RTMI�NT USE ONLY <br /> APPLICATION ACCEPTED BY_______________ ___ _ ___ __ <br /> REVIEWEDBY----------- -----III------------------------ -- -------- ------------ --------- - ------------- -------- ----------------- DATE--------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------•----------------- ------ DATE <br /> Alterations and/or recon►mendations---------------------- -------------------------------------------------- <br /> --------------------------- <br /> ----------------------------------------------------------------------- <br /> !1 ------•-------------•------------------------- <br /> i --------------- •------------ <br /> ---- - <br /> ----------------------- ------------------ - <br /> ------------------------------------------------ <br /> I <br /> FINAL INSPECTION BY-------------- -- --- <br /> - Date f- 4�� <br /> !� S <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> !� <br /> 130 South American 5+rea+ <br /> 300 West Oak Street 132 Sycamore Street <br /> 814 North "C" Street <br /> I <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, California <br /> &* ES-9-2M Revised V59 F.P.Ca. <br />