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FOR OFFICE USE: 41: <br /> 3 t -- ---- .. f�•7 3� <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 /> This application is made in compliance with County Ordinance,No:-549._,.,.. <br /> JOB ADDRESS AND LOCJ1 <br /> , /��3DINt <br /> -------------- ��------------- ----------—/---------- <br /> Owner's Name. ------ = --------------------------------------------------- Phone......'.............-------------- <br /> Address '-------------------------- ....................... <br /> Contractor's Name........... <br /> ---------------------------------------------------------- Phone, <br /> Installation will serve: Residence Apartment House O Gomm ercitil ❑ Tr ler Court ❑ Motel ❑ Other <br /> Number of living units: __3_ Number of bedrooms ,%'___ Number of baths _ __ Lot size .:._.. _fir ""___ _•_ ............ :.. <br /> Water Supply: 'Public system, Community system ❑ Private ❑ Depth to Water Table ...... ft. <br /> Character of soil to a depth of 3 feet:1 Send Gravel Sand Loam Cla$ Loa Clay Adobe <br /> ❑ ❑ Y ❑ Y y ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,dale________ ___________"-)s-'No —N_e—w onstrucfion: Ye,� No E] FHA/VA: Yes [3 NO <br /> TYPE OF-.INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool Permitted if public sewer is.available,within 200 feet.) .. <br /> Septic Tank: Not of compartments}-well______________�-DZeance from foundation <br /> dep�---------------------------- ----- ................. <br /> P Material <br /> Disposal Field: Distance from nearest well___ Distance from foundation------10h.-.pit Capacity S` <br /> _Distance to nearest lot line................. <br /> .� Number of lines-------------- Length of each line------......001____ __-.Width of french------------ +��..�'________ <br /> Type of filter material._._._ __Depth of <br /> dfilter material---_1.ir.F__li___._Total length_-_.....____4_a._.._.___ <br /> ----` <br /> p g Number of its---•-----1__--__- Linin `� ti , 1 <br /> • _ _ Size: Diameter Distance to nearest lot line__.___._....... <br /> 5ee� a Pit: Distance tonearest well----- =__"_9 �Dtetaelce from fou ation______________� 3.3.+r__.Depth.____.....�.�.`..�.____. 1 <br /> Cesspool: Distance from nearest well-------------- Distance from foundation--_.----------I-----Lining material <br /> ❑ Size: Diameter--------•------------------------ f._Depth.---•------------ ------ --------•----------- .Liquid Capacity gels. <br /> Privy: Distance from nearest well_____ ________ ___________________._______,_--_Distance from Larest building___...-.._.____--.---_•_•_.________.__. <br /> ❑ Distance to nearest lot line------- --- -------------- = <br /> Remodeling and/or repairing idescribe):.__ ✓ <br /> - •-'---- ------ --. ._'- J-»------------------•- <br /> ..............................................•----------------------------------------- <br /> ------------------------------------------- -------------- <br /> •-----------------------•-•------•-•._.-__.._----------•------•-----------••-------- <br /> _ ''fit.. <br /> ...- •.-� :- f.�.rw�'c tea*'..'"°� -- �•"; <br /> I herebycertify 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 /> (Signed C __ (Owner and/or Contractor) <br /> �....�.-.�.. .e-.s .1r---- ---------------------------------------- <br /> By:---••-----•• ----- ----- - ------R---------- + ' '�1 l�-....---(Title)----...------------------------------------ <br /> "` (Plot plat:., showing siz of lot, location of system in rel ion tells, buildings,efc., can be placed on reverse side). <br /> 1'� R DEPART ENT USE ONLY <br /> APPLICATION ACCEPTED BY_.._._: __ _ <br /> --- �----�---------------- DATE.......... <br /> :'�_-��"..---r REVIEWED BY BY - - -------------=--- ------••-- ----------- `-----------------.­-----------------------._.. DATE------------------------------------------------ <br /> BUILDING PERMIT ISSUED -------------------------------------------------=--------------- _ DATE:_-:---_'- - _.,..-:---; <br /> -------•------------ <br /> Alterations and/or recommendations:__. ,.. -_____._,__-- _-_ :�- <br /> --F <--= -------•------------------------•--------,----------- •---------------------- <br /> ---•---••----------------------------------------------------------------------- --------------- i� , `i <br /> --------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------••••------- -..- ----------------------------------------1---------------------------------------------------------------------- <br /> -------------------------------- <br /> ......................................... ----------------- P _ - <br /> _ � p <br /> FINAL INSPECTION BY:---- ----------------------- - Date--- <br /> SAN <br /> ate--SAN JOAQUIN LOCAL HEALTH DISTRICT <br />} s" 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wes,9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California J <br /> E® 9 A V19E0 9.59 ZM 8-61 ATLA13 <br /> � ; lr <br />