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FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ....��.......:��:� <br /> ........................ ------------ - - --- -- (Complete-in Duplicate) <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. <br /> I This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AN CATION--- �-f .-- ---- : : ... ------------ (C_ " -'' g <br /> Owner's Name ' ��. -------------------------------------€ Phone------------------------------------ <br /> t' <br /> Address.............c2-L... .. _a ---------------- - --------- ._ ......_. _...-----•--------------------------------- <br /> ------------------------ <br /> Contractar's Name -----/Apartment <br /> -� =: '_ Phone <br /> --- -------------- ------------------------------- <br /> Installation will serve: Residence House ❑ Commercial. ❑ Trailer ourt ❑ Motel [❑ OtFier ❑ <br /> i t <br /> i Number of loving units: __ l__' € ! <br /> Number of bedrooms _ ._ Number o baths -------- Lot size _.._ __ ______ _______ ____i_.____._._______.__._.._-- <br /> Water Supply: Public system E] Community system El Private Depth to Water Table ...... _ it i <br /> Character of soil to a depth of 3 feet Sand 0 Gravel E] Sandy Loam [❑ Clay Loam ❑ Clay i❑ Adobe 0 Hardpan <br /> Previous Application Made: {If yes,date--............ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> L TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> i <br /> (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) I <br /> Sep4icXk: Distance from nearest well.__*Sa.'___Distance from foundation----/.:O '._----- Material.____.--01f r --- t ------------- <br /> No. of compartments---__.._. _r.._.Size __ X, .- __Liquid depth------ .r____ __.. .. Capacity.. �o o . <br /> Dispos Field: Distance from nearest well.................Distance from foundation----1.0___-......Distance to nearest lot line______f_______._ iN <br /> Number of linesY----- ------Length of each line-- -----1_o.P.f----------Width of +ranch `--.Y-�----------------- <br /> Type of filter material__...:fl'JL------Depth'of filter material______ __...---.-_.Total length__.._, e ______________________._ <br /> See Pit: Distance to nearestw ..f.--___Distance from foundation.._____ <br /> 102►____.Distance to nearest lot line____S____ _______� N <br /> } Number of pits--- -------Y--- Lining material-----}S�J------ Size: Diameter------,3�."r.__.Depth`r -S------------------ 1Z <br /> pmaterialk <br /> ❑ Size: Diameter- -- t Depth-; - -- -- - R-- - ---- - .Lining material- � ------`---�----------------------- <br /> Ce-ss ool: Distance from nearest well _______________Distance from foundation. .: \ <br /> t h------------_.Liquid Capacity -- -- ------ -gals. <br /> Privy: Distance from nearest well_._.__.___--- from neare <br /> ___________._:___.._._._ Di <br /> --_...._ stance st building------------ <br /> r ❑ Distance to nearest lot line # ---------- -•---------------------- ---------------------------------- "- ---------------------------- <br /> Remodeling and/or repairing (describe)--------- - -----------------------#----------------------- r i <br /> I _ __ , I <br /> ------------------------------------------- ---------•------!----------------------------------------------------------------- I ---- ---- --------- -- ------ <br /> ------- - ------------------ <br /> i I hereby certify that I have prepared this,application and that the work will be done in accordance with 'San Joaquin County <br /> k ordinances, State laws, and Crulend regulations of the,San Joaquin Local Health District.(Signed) - - --- -- -------- -------------------- , and%or Contractor} <br /> BY:---------------------•--------- ---•-•--- -----------�-- - --- -- --- -- - -=------- - --- -------------{Title}---------- -- -5---- - ----------- <br /> (Plot plan, showing size of lot, location of system in rela ion to IIs, buildings, etc., can be placed on'reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.- -' -------------------------------------------------- ------ DATE---- --- -- <br /> REVIEWED BY---- ------------ ------ -- -- -----• DATE---------- <br /> - -- ----- �----- - <br /> BUILDING PERMIT ISSUED---------- ----------------------------------------------------------------------------------- ---- DATE ------------ <br /> Alterations and/or recommendations:------------------------ ------- --- ---- ---- -----•------- ------------------------------- ------ -------------------------------•---------------------- <br /> r <br /> i <br /> ----------------------------- ----- .-.---- --- ------------------------- <br /> ----------------------------------------------- <br /> FINAL INSPECTION BY:-. --------------------- Date---- --� ...................... - ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi:California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard press <br /> a <br />