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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...C.. ............. <br />------ ----- ---- --------------------------------------- (Complete in Duplicate) Date Issued .f'G <br />--------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> A.... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instalAp work herein clescribadv <br /> This application is made in compliance with County Ordinance. No. 549. <br /> JOB ADDRESS AND LOCATION. .= .- _ __. __ <br /> Owner's Name-- - ------ <br /> Phone-_c 1.1f_- Y.- 7 i . <br /> - - -- <br /> _� •• <br /> �' <br /> Address ---'--'-•-- -'-'-• --- --- --- - -�-----------a----- -----_-- <br /> Contractor's Name------ f ------------•---------•------•-----•-- Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 <br /> Number of living units: - --_-_ Number of bedrooms 1''--_ Number o baths _/-..._ Lot size _--- - <br /> Water Supply: Public system ❑ Community system E] Private Depth Wafter Table _...... ft. � ' <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] 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: I f . I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S,, ti ank: , Distance from nearest well...... 4P-- Distanc fro j�fundation_-- - Material No. of compartments---_._ �__.-__-----Size_ ___ 11- __Liquid depth. ........----------Capacity_._. x..42 <br /> Disposa field: Distance-from nearest well-�D__..----Distance from foundation--- ------.---.Distance to nearest lot line---S..__.... <br /> Vr *Number of lines----------- --- -----.-__ :.- Length of each line-------Zz-110qq-`.._.-.--.Width of trench ............... <br /> Type of filter material. ---.Depth of filter material-----4 )----------Total length- d.......................... <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line--.......... <br /> ❑ Number of pits----------------------Lining material------------------ ----Size: Diameter..........-------------Depth---------------------.----------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------_----•-----.-..- <br /> Size: Diameter--------------------------------------De th--•----•----------- <br /> p --------------------------------Liquid Capacity---------------------•------gals, <br /> Privy: Distance from nearest well----------------------------}------.----- -------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line...------------------------ ---------------------------- . ........­- ------------------•--------•--•--•-------------•-------------- <br /> femodeling and/ repairing (de�scribel:------_---- --. e .__ -....--••-_-• <br /> a <br /> • -•--- rEz'G`" <br /> --------------•-----------------•-•-•------------------------- ...................... <br /> --------------•---------------•--------•---""------------•`--------------------•------------`i••-'-•-----------•-•-----.-..-..__...-_....•----.-----._-..-.---•-----------•--••---••------•---------------I_------------ <br /> hereby certify that I have prepared this application and-that the work will to done in accordance with San Joaquin County <br /> ordinances, State 1 , and rules an regulations of fto San Joaquin oval Health District. <br /> G � � <br /> 6 <br /> (Signed) -.Vi �i <br /> - ---- --- -------------------------- rand/or Contractor) <br /> ----------------------------- <br /> By................. ..--- Title)-- ----------- - --------------- <br /> (Plot plan, showing size of lot, location of system in relation to wengs, etc., canbe placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- --- - - ---------------- ---------- --------------_------------ DATE..-?--_ .. . ------------------------------ <br /> REVIEWEDBY------------------------------------ --------------•------------------------------------------------------------------------- DATE------ -----•--------- <br /> BUILDING PERMIT ISSUED.....-------------------------------------------------------- --- DATE-----------•------------ <br /> Alterations and/or recommendations:_---- ----•-- ---------------------------------------------------------------------------------------------••----•--------•------------•-•----•-------------- <br /> •-•---- ----------------------------------------------------------•-•----------------•------.-..--•-------- ----------------------------------------------------•------------------------------------------------------------- <br /> -------------------------------------------- <br /> FINAL INSPECTION Date_�p - ----------- <br /> . <br /> _---------------------------- <br /> ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-59 RM 5-61 AILA9 <br />