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FPR OFFICE USE: k <br /> n <br /> 3 ---------------------//7n <br /> APPLICATION FOR SANITATION PERMIT Permit`No. ... - . <br /> (Complete in Duplicate) <br /> 1. 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 C Ordinance No.. 549` <br /> ----------------- <br /> (� vL <br /> JOB ADDRESS AN LO ATION_------- ___ _ n _ ----- ------ --------------- <br /> Owner's Name--: ----------- - -- - - --------------------------•---------------------- - --- --- ---- -- - ----------- ------- Phone--------- ------------------------- <br /> Address ----•- --- <br /> G6� <br /> Contractor's Name.---------•---- ------- - ----------------------------------------- ---------------------------- Phone----------_-.---•---------------- <br /> Installation will serve: Resident Q`Apartment House ❑ Commercial E] Trailer Court ❑ Motel E] Other Elplumber of living units: __ ----- Number of bedrooms -_Number of baths ._ ---- Lot size ___. ------------------------- <br /> Water Supply: Public system ❑, Community systemPrivate ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan E]Previous Application Made: (If yes,date____________________) No New Construction: Yes El 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 /> I <br /> Septic nk: Distance,ifrom nearest well_________________Distance from foundation--------------------Material----.-_-----.--._--.-_-_-.-._----_--...._-------- <br /> �f No. of compartments--------------------------Size--------------------------------Liquid depth---------- ------------- Capacity----------------------- <br /> Dispos ield� Distance 'from nearest wellyQ.�__Distance from foundation___l8_.._.____.Distance to nearest lot line_ ____..- <br /> Number of lines___/_______ Length of each line__---.{L2_'----_ --Width of trench_ �_`�_.._______.____.. <br /> Type of filter material QL�.___--Depth of filter material__I�(___7-----------Total length-------�--0------------------------ <br /> Seepa Pit: Distance"to nearest well_--.~Da..____._Distance�fr1,y� foundation___�d___._._..Distance to nearest lo# line._._ <br /> Number of pits--------I------------Lining material__-_`L[U..L.AC.Size:. Dia meter---. 3.-�._-_-___Depth----- CS`�.__--------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------.--------------------------- <br /> ❑ Size: Diameter----- ---------- ---------------Depth------------------------------ ------ -------------Liquid Capacity---------------------------gals. <br /> Privy: Distance 4rom nearest well-------------------------------------------------Distance from nearest building--------------------.___-______---_-----. <br /> ❑ Distance:to nearest lot line--------------------I------------------------------------------------------------------------ --------------------------------------------- <br /> Remodelingand/or repairing (describe):---------------------------------------------------------- -------------------------------------------------------------•-------------•----------------- <br /> I ----------------------------------------'---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- <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, State law nd "rules and regulati ns of the San Joaquin Local Health District. <br /> : <br /> (Signed) -------------------------------------------------Owner and/or Contractor <br /> BY: ------------`----•--••-•----------------------------------------------------------------------------------------(Title)--------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE---- -- ----- .f <br /> '---------------------------------- -- <br /> REVIEWEDBY-----------------------'----------------- ------------------------------------ --------------------------------------------- DATE----- ----------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- <br /> Alterations and/or recommen t•o s' ------- ----- - ---- -- --- ------`- - ---------------------------------------------------- <br /> d'= -Gs ------------ - - ------� � <br /> 11 -------- ------------------- <br /> --------------------------------------------------------------------------------------------- ----•- --------------------------------------------.-------------------------------- <br /> -------- --- --------------- ---------- ----------- ---------------- ----------------- --------------- <br /> ---------------------- ------------- ----------=---------------------------------------- -- ------- ---- ------------------------------------- --------- -- ------------------------------- -------------------------------- <br /> FINAL INSPECTION BY-- ------------C=- Date "^ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasalton Ave. ° 300 West Oak Street 124 Sycamore street 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r•.a.co. <br /> I <br />