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7TR OFFICE USE: <br /> f <br /> Y­4 <br /> �4 --5-------------- I <br /> ___-��.//-.-4..................... -- APPLICATION FOR SANITATION PERMIT Permit No. ..... ._____... __ <br /> 3 � � s <br /> �:__-__ <br /> (Complete in Duplicate) <br /> -- -- ----- <br /> This Permit Expires 1 Year From Date Issued Date Issued ___l6_ _la3 i <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&��108 ADDRESS AND LOCATION---- ��- _--_+. ________ ________ _ <br /> Owner's Name-------- -------------------------------------------- <br /> Address-. <br /> ----------------- Phone r <br /> �r <br /> Address----•-••--•----•---------� !__ -4:,._------ -- - -- - ----- - ------------ -------------------------------------------------------------------------------------------------- <br /> Contractor's Name------------------------------------------------------ -- - -------•- ---- -- --- ----------------------------•-- ................ Phone_ _^ <br /> Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __L-- Number of bedrooms -C;2,Number of baths -------- Lot size ________________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table !s� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe>( Hardpan ❑ <br /> Previous Application Made: (If yes,date-----------_------__) 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 200 feet.) <br /> eank: Distance from nearest well_________________Distance from .foundation--------------------Material------------------------------------------------- <br /> No, of compartments ;Size Liquid depth Capacity <br /> pXi o field: Distance from nearest well.---------------__Distance from foundation--------------------Distance to nearest lot line----------------- <br /> I <br /> Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material________________________ epth of filter material---------------------Total length-------.---------------------------------- <br /> Distance <br /> ----...__-___-__--_----__---_--- <br /> i <br /> Seepage Pit: Distance to nearest well_7<p__1d.�__Distance om f ndation____114-__.-..Distance to nearest lot line--/o-------- TM <br /> Number of pits-----/--------------Lining material__/� .-Size: Diameter--.� ---��-. --Depth----- PS-�------------- <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----------.---------------.---------_---_ �r <br /> ❑ Distance to nearest lot line------ ------------------------------------ -------------- - (� <br /> r <br /> Remodeling and/or repairing (describe)--------------------------'------ -------------------------------------------------------------- -------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------,---------- <br /> I hereb a 'fy that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances fate aws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ` - ------ - -{Owner and/or Contractor) <br /> - ---------- --- ----------------------------------- - <br /> B - ------------------------------------- Title <br /> (Plot plan, showing size of lot, location of system in re6ai-onto wells, buildings, etc., can be placed n reverse side). c <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------C--•--- ss --------------------------------------------------------- DATE--- = �.�------------------- <br /> REVIEWEDBY---------------------------------------------------------- ----------------------------------------------------------------- DATE---------------------------- ------------------------------ <br /> BUILDING PERMIT ISSUED----------------------------------------------------- --------------------- DATE ----- - <br /> Alterations and/or recommendations:__.1_SJ'3C7._ ti__.____ .L1 S_ W-_'�__._---_�_ �_ -_. ` ______.__ <br /> p �y <br /> -----` ae"f- <br /> ' 1 <br /> ----------------------------------------------•------------ ------------------ ---- ---------------- <br /> FINAL INSPECTION BY:.-- . - - -- ---•---------------- Date--- --..----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haseiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 6.59 3M 3•'63 F.P.DD. <br /> 1 <br />