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r FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. .o?__.___ 1 <br /> --------------------------------------------------------- -- <br /> - <br /> --------------- ------------------------- (Complete in Duplicate) <br /> Date Issued <br /> ----------------------------------------------_------_ I 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 County Ordinance No. 549. <br /> °'�'� -- -------------- " <br /> JOB ADDRESS AAN�DD OCATI 10___ ° _ t C� / - -- '� <br /> Owner's Name--4✓5 '�---- -- ------ Phone--------------------------------•--- <br /> Address , 9 <br /> - ----------•-•------.......... <br /> ------------------ <br /> r --------------------------­--- <br /> Installation <br /> Contractor's Namet�-s.ra f '" "�" z`e --- ----------- Phone---------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ __ Number of bedrooms -c;,. Number o baths __/__- Lot size ._ -s$ --__________________ <br /> Water Supply: Public system ❑ Community system ❑ Private Number <br /> t ater 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----------- ------.-) 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--------------------Material____-___________________,___________-___-__-____- <br /> ❑ No. of compartments-----------------------Size--------------------------------Liquid depth-------------------------Capacity-----------•---`----- <br /> Dispos Field: Distance from nearest well--- .'-_Distance from foundatiojl•<e--------------Distance to nearest lot line___________ <br /> Number of lines--__________�______ __________Length of each line_______Q__--___-��____-__Width of trench-_1__/___,_____________________ <br /> Type of filter material_____.'k_K_►----.__Depth of filter material----/__!___ _______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 /> 17­1 Size: Diameter-------------------- ----------------Depth-------- -------------------- ----------------Liquid Capacity_-------------------------gals. (N <br /> Privy: Distance from nearest well------------------_------------------------------Distance from nearest building-------.-_____________________-__-_____._. <br /> ❑ Distance to nearest lot line----------------------------------- --------------•------------•-----------------•------------------------- ------------------------ <br /> Remodeling and/or repairing (describe) --------------- <br /> ---- - - --- ' ------------------------------------ <br /> --------------------•--------------------------------------------=- - -aIL R-- �'---- � ------ --- - ---------------------------------------------------- <br /> •----------------- ----------------------------------------------------------------------------__------------------------ �---------------------------------------------------------------- <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State s, and rules and re lations of the San Joaquin Local Health District. <br /> -----Ling <br /> ------ ----- -- --L <br /> - ------------------------------------------------------------------------- --------- <br /> (Signed) rand/or Con+rector) <br /> A C2- <br /> By.• Rlot, location <br /> ------ ------ ---- ------------------------------------------------------(Title)--------------------------------------- ------------- <br /> (Plot plan, of of s fern in 4 ation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ <br /> -- ------ -------- ------ ------ - -------------------------------------------------------- DATE----2--7��---------- <br /> ------- ------------------------ <br /> REVIEWEDBY------------------------------------ ----- -------------------------------------------------------- DATE------ --------------------------------------•-------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------_------------------------------- ----• DATE------------------------------------------------------------ <br /> Alterations and/or recommendations------------------------------------------------ ----------------------------------------------------- •--------------------------------___-------------------- <br /> ---------------------------------------------------- ---------- ---------------------------------------- --------------------------------------------•---------••---•••---------- -•---•-----•-------------------------- <br /> ---------- ------------------------- -------- --------------- ------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------- ---------------- -------------------------------------------------------- ------------- --------------------- ----------------------------------------•------ -------- -------------------------- <br /> FINAL INSPECTION BY: ----------------- Date-2. .......... ------------------------------------- <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 />