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FOR OFFICE USE: d ,. <br /> --------------------- ------------- .-___.____._ APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------------- ----- (Complete-in Duplicate) <br /> -.-.-.---._ --_--.--- 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. 549. <br /> JOB ADDRESS L ATIO -� .--LUr--( 1 '�u - d------��__ -__ --------- ry ---- <br /> Owner's Name---- -. Phone--------------------•--------- - <br /> Address----------------- -•- -• �1� -GL�---L £ <br /> --------------- <br /> Contractor's Name-- ------ ----------- ------ ---------- -- ^-`- Phone. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer ourt ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms. Number of baths-------- Lot size ---- —------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private Ek"6epth to Water Table ------ - 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-_________________ I -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 /> Septic Tank: Distance from nearest well-..-- Distance from foundation-------------------Materia! ............................................... <br /> . <br /> ❑ No. of compartments-_- ------------/__Size------------------- -----------Liquid depth------- - ....... ....... Capacity-••-------------------- <br /> Disposal field: Distance from nearest weft.................Distance from foundation-- G---�--_..Distance to nearest Iodine---` -- ------ <br /> 711-F <br /> ----- <br /> Number of lines --------*-1-....-----.h Length of each line-- --_-- --4_---------___Width of french.....�------------------------- Q <br /> f Type of filter material---------a?_/4 _.-Depth of filter material-------- --�----Total length-----_-V_Q--------------------------- <br /> Distance to nearest wek!-------9&"-.---,Distance from fQun dation---1A---------- to nearest lot line--.--- -------- <br /> Number of pits._ ------ - Lining material---------- Size: Depth- ---------------------- <br /> Cesspool; Distance from nearest well --------------- from foundation----------------. ..Lining material-------------------------------------. <br /> ❑ Size: Diameter- -- - ------- -- -- ----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, <br /> Privy: i Distance from nearest well------------------------ ----_----- _-Distance from nearest building-------_----------------_--._--.--------. <br /> ❑ Distance to nearest lot line - ------- --- - ------ - --- ------------------------------------------------------------- --- <br /> Remodeling <br /> -Remodeling and/or repairing (describe)---- -------- ----------------- ^�----------- --- --- -- ---------------------------- •------------------ <br /> ------ - <br /> F <br /> ------------------------------------------------------------------------ -------------------------------- -----------------------------------------------------------------------------------_----------------_----------' <br /> I hereby cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat la , and rules and r tions of the San Joaquin Local Health District. <br /> (Signed)-------- ----------- ----------- --- ---- ---- ------------ -.-------------- ----- ----------------- ---•---------------------- --------- --" 'and/or Contractor) <br /> By: --- ------ ----- --- ------ ------ ----------. -------- ------ --- <br /> --------------(Title)--------------- - - <br /> (Plot plan, s ing size of lot, location of stem in re tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- .. - -- - • c.� ---------------- ------------------------- -------------- DATE--.Y._' <br /> -- ------------------ <br /> REVIEWEDBY---- ------------------ ----------------- ------------- --------_------------------------- ---------- ------------------ DATE <br /> BUILDING PERMIT ISSUED---------- ------------------- ---------------------------------------------------- - -------- ------ DATE---------------- <br /> --------------------- <br /> Alterations and/or recommendations:------------------ ---- - --------- - - ---------------------------------------------------- ----------- ---------------------------------------- <br /> ----------------------------------- ----------------------- ............ -- -- - -------------------- ----------------------------------- ----- -------------- •----------------------------------------------------------- <br /> ---- ---------------------------•---------- ---------- ------------------- --- ---------------------- ------------.----------------------- ---------------------------------------------------------------------------- <br /> FINAL INSPECTION BY I,/ -- ------------ Date . - .' - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vuriguard Press - r <br /> '4, <br />