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FOR OFFICE USE: <br /> - APPLICATION FOR SANITATION PERMIT Permit No. Z ../ <br /> ---------------------- -------------------------- <br />--------------------------------------------------•------ (Complete in Duplicate) Date Issued ---- <br /> ---------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued D( 9 -O,—U—0/ <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 Ordinan a No. 549. <br /> .._ <br /> ----- <br /> JOB ADDRESS AN CN P_��_._(la.�.-- ----------- --•----- ------------------ - - • ----------•---•-•----------.... <br /> Owner's Name---- -- `---CIL.----••... Phone <br /> Address------�, . ---•-•-=------ ------ •----------••------ <br /> Contractor's Name-------••-------------- ---------- ...-------------.........------- Phone <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ff f r <br /> Number of living units: .... Number of bedrooms A--- Number of baths .l. <br /> .. <br /> Water Supply: Public system [�ommunity system ❑ 'Private ❑ Depth to Water Table d- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam e Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No 2�FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> septictank or cesspool permitted if public sewer is available within 200 feet.) <br /> jtNo <br /> k• Distance from nearest well_________________Distance from foundation_____-_---________Material______-_.._______----.-.---------------..._.-.--. <br /> No. of compartments---------------••---------Size----------------------...---1---Liquid depth--------------------------Capacity.:..................... <br /> 0 1 F Id: 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 filter material--._.-_-----------------Depth of filter material.......•---------------Total length-----•...._.----------------------..�.--- <br /> •-r <br /> Seepage it: Distance to nearest wellp� -_Distan r m f ndation__ -----_...._..Dis,ankh to nearest lot-line� .r-_ <br /> Number of pits___.__------------Lining material f�---Size: Diameter-3.0.............Depth_ . -.-----1: <br /> © r <br /> Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material------------------------ <br /> ---------- +� <br /> ❑ Size: Diameter. Depthi <br /> , <br /> ------------------------------ ud Ca acitY ' ---••--..---•- als. �1 I <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building--------------------------------.......... <br /> ❑ Distance to nearest lot line______ ________ <br /> S <br /> Remodeling and/or repairing (describe):_____. d <br /> --------------- <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, S e aws, and rules and gulations of the San Joaquin Local Health District. <br /> w <br /> ct <br /> or)(Signed ---- ------ - - wner and/or Contra <br /> (Title) {B • ------ ...............................................(Plot plan, showing size of lot, location of systeniin relatioowel <br /> (� <br /> buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- - a DATE. .' <br /> REVIEWEDBY----------_--•-------------------------------------------------------------------------------=--------------- -------- DATE-------- <br /> PERMITISSUED--:.•---•----- ---------------------- ---------------------------------------------------------------- DATE---------------------....----------------_--------=•----- <br /> Alterationsand/or recommendations---------------- ---------•------------------------•--------••----------••-•-----------------...------------------•--....-----••--------•----•-•-------•---- <br /> --------------------------------------------------•------•-----------------------•-------------------- ---------------------------•-------------------------•--------------------------------------------------•------ <br /> FINAL INSPECTION BY:. --------------------- Date---t7. '`� --------- ------ <br /> 1 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Locil,California Montsca,California Tracy,California <br /> ES 9 REVISEo B-89 2M 5-61 ATLAS <br />