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FOR OFFICE USE:'� ­,, <br /> ------------------------------- <br /> ---------------------- APPLICATION FOR SANITATION PERMIT permit No. <br /> ����� v <br /> ------------------------------ ----------------------- <br /> - ------- ------------------- ----------- ------------- (Complete in Duplicate} Issued Date,Issued <br /> ------------------—------------------------------------- This Permit Expires I Year "From Date <br /> I ' <br /> Application is hereby rnacle-to the San Joaquin-Local-Healfh-District,for�.a�'permit,to construct and.install the-wo rk herein described. <br /> This application is made in compliance with County Ordinance No, 549. <br /> ............................................. ....................... . <br /> JOB ADDRESS AND L CATI N---- --- ---- -- -- -I--------- <br /> Phone. <br /> Owners Name--- -------------- <br /> Address <br /> ....... -------- <br /> Contractor's .. <br /> Nam --- ------ --- ---- -- ........................ Phone <br /> House [] Commercial Trailer Court 0 Motel Other 0 <br /> Installation will serve: Residence partment H k AO <br /> Number of living units: ../--- Number of bedrooms Number of baths .-/-- Lot size ---------I---------- ................... <br /> )1� e ft.40� <br /> WaterSupply: Public system E-1 Community system C3 Private &--D"epth to Water Table <br /> r Clay C] Adobe&—FTa_r_dpan ❑ <br /> Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam ❑ tla� Loam 0 <br /> A- Yes ED No <br /> /V, <br /> Previous Application Made: (If yes,date--------------------1 No [�' New Constructi6n: Yes,E��o 0 FHA <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee <br /> t.) <br /> Material_.._""""""__"' ............................... <br /> e-11 --------Distance from foundation-----_!.?.'.-"----- <br /> ptic Tank: Distance from nearest w --------- -------------__..Liquid depth--------------------------Capacity-------------- <br /> 'pti"an <br /> g I <br /> No. of compartments---------------­---------Size_"... --------- <br /> est lot line................. <br /> .......Distance from foundation--""....._•....N.Distance to near <br /> Dispo�a field: Distance from nearest well---------- <br /> 1; :---------------_------- <br /> -----------Length of each line--------•-------------------•.Width of trench ------ <br /> Number of lines---------------- ------- <br /> Type of'filter material-------------------------Depth- of filter material----------------I-----Total length-_-....................... OF <br /> \ , <br /> Distance to nearest well__/_ ,��gO---1----Distance from. f dation__/0_r-----1_._,.DWance to nearest lot line ...... <br /> Seep ge Pit: S <br /> Number of pits i:�r4oml ize. Dia meter- --------Depth---- -- <br /> ....../--*----------Lining material I <br /> rn� Lining,material------_------------------I......... <br /> Cesspool: Distance from' nearest well-----------_----Distance from foun8laflion-- ----------------- <br /> ❑ <br /> ILiquiJ"Capacity.-------------!...............gals, <br /> Size: Diameter--------------------------- Depth------------------------------- --------------- <br /> tanc;a,,from nearest building---------------------------------------- <br /> Privy- Distance from nearest well-__-__-""""_-"""--------------------------!- -----Dis , . I. I <br /> Distance to nearest lot line-----------------------------------------I---- - ---- ----------------------------------- ...... -------- ------------------------- <br /> Cl <br /> R e m o d5 e llipn and/or repairing --lea - <br /> --------------------.......... ------ ----------- ----------I--------------------------- <br /> --------------------- ------- ------------ <br /> .............------------- ----------- <br /> ------------- ----------------- <br /> F..... ------------ ------------------------ ---------------­----------------------­­ ----------------- --••-----"-----•------------•----•----------•-- <br /> .......... 21 <br /> --------------------- ------------- --------I---------------------------- <br /> I ................. -••--- <br /> -- --------­­­'------------11------ <br /> 1 .1--------------------------------------------------- 7- ------ - -------- - <br /> ---------11.'.hereby.-certify--that I­have.-prepared this appli ion d tha�t.the work-will-be done in accordance with San Joaquin County <br /> ordinilincest State laws, and les d regul ions o e Joaquin Local Health District. <br /> (Ow al, <br /> -------------------------------- �w and/or Contractor) <br /> S 1� <br /> (Signed)-- ---- - -- ----- <br /> B -- --------------•----------------------------------------- --------------- <br /> d ----- 0. <br /> etc.. can 69 p iced on rev side). <br /> (plot p1la size of I I cation of system in relation to wells, buildings, etc.. can 69 <br /> FOR DEPARTMENT USE ONLY <br /> - -- -------------- ............�­6.1­DATE-APPLICATION ACCEPTED BY ------- ------ <br /> PPL <br /> ----------------------- .... <br /> -------_-'--------- DATE................ --------------­ <br /> REV19WED.BY, ....... ------------- - --------------------------------------­: <br /> -------- -------------- <br /> U D DATE--------------------------------------------------!-------- <br /> -- -------------------------------- <br /> BUILDING PER-MIT-ISSUED------------------------------------------------------------- <br /> I , _­-- <br /> -\------------------------ ----------------------------------------------------- <br /> Alterations and/or recommendations:'w--- ---------------------- ---------------------------------- --- - <br /> 1�; \- ------- ................!--------- <br /> - ------"----------••------ <br /> -- <br /> ---------- -.---------------------------------•---------------------------------------------------------------------"----------- <br /> • <br /> --------- -------- --------- ----------- --------------- ---------------------------------------•--------"-----------------••-------------"_;"...-----------------•"".----------------- <br /> ----------------------------- I <br /> ----------------------- <br /> -------------------- .................. - -------- --------------------------------------------------------------------------------------------------------------------- <br /> Date------ ----------------- ---------------- <br /> FINAL INSPECTION B*...... -------- -- ------- ----•---------------- <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,Collf*mla Manteca,California Tracy,California <br /> ES 9 REVISED 8-139 ZM 5-61 ATLAS <br />