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FOR OFFICE USE: <br /> --- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..f.f. <br /> ---------------------------------------- -------- (Complete in Duplicate) l Gs <br /> --_ --- I 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. S <br /> JOB ADDRESS AND LOCA ION._ b:.�- <br /> e�l(' ;----------••------••- - <br /> Owner's Name....----- ........ ------ Phone................................... <br /> Address------------- .. . •--•- <br /> Contractor's Nam K-2----------------------------------------------------------------............................... Phone................................... <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelOther <br /> Number of living ❑ <br /> units: __:__: Number of bedrooms __ �� �Wumber of baths __.._� Lot size -------------------------------------------•-•---•-•------•• <br /> Water Supply: Public system [rCommunity systerri ❑ Private E] Depth to Water Table 1111-ft. <br /> .>.-. <br /> Character of soil to a depth of 3 feet: Sand GRIG_ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (!f yes,date--------------------) No New Construction: Yes Ok"No ❑ FHA/VA: Yes ❑ No Fj­ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> SeV <br /> nk: Distance from nearest well -Distance from foundation_ _D__'F_._�..Material_ ,Pt <br /> (No septic_tank or cesspool permitted if public sewer is available within 200 feet. <br /> . <br /> -,No. of compartments....s1__-_________________size------3:�{TX:.�__,___Liquid depth---�------------------Capacity.-���...... <br /> Disposal Field: Distance from nearest Distance from foundation.JA_.....--•-___.Distance to nearest lot line.... ....... <br /> Number of lines._.:.. Length of each line_ ____ <br /> 0� -- -------------- g 73.I =-2-0-------Width of trench......4.Y-------------------- <br /> YP p -------Total length---- •------- ........ <br /> T e of filter material-Z44_-�.�__---___De Depth of filter material__>�______ <br /> Seepage Pit: Distance to nearest well_____ ______________Distance from foundation__---__--_-_---___.Distance to nearest lot line................. <br /> F1 Number of pits----------------------Lining.material......-_...-------------Size: Diameter----------------__,-,____,Depth................................. <br /> O <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- `31), � <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well-----------------------------------------------._Distance from nearest building--____-.________________._--_______-___._. <br /> ❑ Distance to nearest lot line-----------------------------------------------------------------------------------------------------------------------------------•••- ----- <br /> Remodelingand/or repairing (describe):--------- -----------------------.......................----------------------------------•--•---•=---- .......-••-------------------- <br /> -----------------•--------------------•-•-------------•--------------•---------------------•--------------------------------------------------------•-••----•-------------•------•-•------••-----•-•------------------------- <br /> ---------------------------------------------------------- <br /> ------- --•--•-------•------•------------•---•-•----•----4systioipn <br /> -------------•- -- ---------- -------•-• ----------------------------------------•-----------••-------------------------------• <br /> I hereby certify that I have phis apps' ti and that t ork will be done in accordance with San ,Joaquin County <br /> ordinances, State laws, and rules ations t San Jaaqu' oca! Health District, r <br /> (Si reed I <br /> 9 )-----.....-•-•-------------- -- - - - -•---- - --- ------- -------•---._...-------------------•---------- -----------------(Owner and/or Contractor) <br />_. BY=---------------------------------------- -------- -------------------------------•---------------------------------(Title) - ----- -' <br /> (Plot plan, showing size of lot, locationste in relation to wells, buildings, etc., can be,-placed-on reverse side). <br /> FOR DEPARTMENT USE ONLY t <br /> b <br /> APPLICATION ACCEPTED BY---------------------------------------------------------------- -- -- <br /> --- DATE-- <br /> REVIEWEDBY------------------ ------.........---- ---------------------------- ---------------------- ------- ...---............ DATE------•------------------------ -------------------------- <br /> BUILDINGPERMIT ISSUED-•--------------------------------------------------------------------------------------------------- DATE----•-------...---..---------------------------•--------- <br /> Alterations and/or recommendations: `......:......•-- -i--•-----------....--------....-------------------------------••---------•----•---- <br /> ---------•----•----------------•---------------.----------------------------------•-----------•---------------•------------------------------------•-------------------_-----••-------..•---..._...---------•----............................................ <br /> ------------------•--------------------------------------------- --------------....------------ ------------- --•------------•------------------------------------------•---------- ..... ------.............. I <br /> i <br /> --- <br /> --------------- ------------------------ -------------•----......_......--------.......---------------------------•---...__.- <br /> ............................. ................ ------ <br /> FINAL INSP ---- -- ---- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 114 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 6-61 AtLAS <br />