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FOR OFFICE USE: <br /> ----------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . <br />------------------ - - ----- (Complete-in Duplicate) <br /> Date Issued <br /> - -- ---------------- 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 549. <br /> JOB ADDRESS AND LOCATION........ ­---------------------- <br /> o0- -�A_-R--y----- srfjP-�''��j----------------- .....................................' � °� Z_—­ <br /> Owner's Name-------... <br /> ------ - -------------------------------------- Phone <br /> Address........................................................ tC3---------------------------------------------------------------------------------....------------------------------------------- <br /> Contractor's Name ,st:�� . � �`afExf _ `�.__�__ �z _�_ ` <br /> L -- --- - - �- 1-------- r-r- ---------------------------------------------- <br /> Installation <br /> -------------------------------------------Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._.-_-_ Number of bedrooms j---- Number of baths---I--- Lot size ---- `_. _,,�__Q_Q__�---------------- <br /> Water Supply: Public system x Community system ❑ Private ❑ Depth 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_.----------------- ) 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 /> ti T k; Distance from nearest well-----------------Distance from foundation__-__----.---___-._.Material -------.--_._----_---__--_.-_____---.-_.--_-.--. <br /> No. of compartments-------------------------Size-------•------------ -----------Liquid dent--- ------ ------- Capacity-----------------� <br /> Di oral Fuld- Distance from nearest well-t4o-ge-._Distance from foundati n------ _J__---.Distance to nearest lot line__0........ <br /> Number of lines_____�44�4 <br /> ___--_-_ _-__._Length of each line__. 1_+O!_-._.____.Width of trench--c-Z. <br /> if_ <br /> -4 10 d C( Type of filter materi ` Depth of filter material ----.-.Total length_______________ ______� ----_-_.- <br /> YP ��-- P <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_____-.------__-• <br /> ❑ Number of pits.-------------.--_.--Lining material---------------------- Size: Diameter---------..------------Dept h---------.--._.--_-___._---__--.- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation-----------.----- ..Lining material-.----------------------------------- <br /> 0 Size: Diameter- -- -------------- ----------------Depth------------------ ----------- ---------------------Liquid Capacity---•----•-------------_---gals. <br /> Privy: Distance from nearest well------------------------------------------.------Distance from nearest'building--__-___--_--_-__-___-_--_----._-.-.-. <br /> ❑ Distance to nearest lot line ------- ------------------------------------------------------ --------------=------------------------------------------------------ <br /> Remodeling and/or repairing (describe):-_ _._. . .. �____._. _ - ---------- -------------------------- <br /> -------- ------ - --- .� -- C � -----------__...------------- -- <br /> ---------------------------------- <br /> I----------------------------------------------------•---------------- <br /> ----- ------------------------------------------------- - .. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Jo quin Local Health District. <br /> (Signed)---/F /C E'f` `''E lM tom:' = ' ' ------; - ----------( Owner and/or Contractor) <br /> By:-------------------------- ----------------------- ------------------------------ :----------(Title)------ ------- -------------- ----------------- <br /> (Plot plan, showing size of lot, location of system in relation t wells, buildi s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - = fe�Q �` Q' r ----------------- -------------- DATE.. 1..=.7--- --------- --------------- <br /> REVIEWEDBY--------------------------------------- ------------------ ---------------------------------------------------------------- DATE---------- ------------------------------------------------ <br /> BUILDING PERMIT ISSUED---------- ---------------------------------------------------------------------------------------- DATE----------------------------------- - <br /> Alterations and/or recommendations----- -------- ------------ - ---------- .......--- ------------------------------------------------ ------------- <br /> --------------------------------- --------------- --------------------- --------------------_---------------------------------------- <br /> ----------------------- ---------- ----------------- -------------------------------------- - ---------------------------------- ----------------------------- <br /> FINAL INSPECTION BY:._. _ d.l_ .lal--------- Date----�-- y----E----- ------- ---------------------------- -� <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 Vanguard Press <br />