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r FOR OFFICE SE: <br /> APPLICATION FOR SANITATION PERMITS �` 6 <br /> Permit No. ._...... <br />---------------------------------------- <br />________________________L._�___ ___ __ _. (Complete in Duplicate) / 1 <br /> - �' Date Issued ... <br /> /.�... �� <br /> _____________________________________________ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a perm* to construct and install the work herein described. <br /> This application is made in compliance with County Qrdinance No. 549. <br /> JOB ADDRESS AN LOCATION.... _ _.. . <br /> ---------•-•----------•----------------------------•-------------------•--•--•------••--•-- <br /> Owner's Name--- - --- ------------------------------------------------------------------------------------------------- Phone.................................... <br /> ----------------•-----------------------------------------------------------------------------------Address 13 rs <br /> Contractor's Name--------- ------ ........................................................... Phone................................... <br /> Installation will serve: Residence 0j"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: -----L Number of bedrooms _--J�'___. Number of baths _/..... Lot size ...... ` ......... <br /> Water Supply: Public system ❑ Community system ❑ Private E]-- Depth to Water Table J5 .. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q--"Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No 5__ New Construction: Yes [_"o ❑ FHA/VA:Yes ❑ No 13— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta k: Distance from nearest well.►1�________Dis#ante from foundation•__��-..__._.__.Material... _________________________ <br /> lbNo. of compartments---- _____________Size---- --------Liuid de th_-$�_.._____._-_-_-_.Ca aci <br /> Disposal Field: . Distance from nearest well-_ �_. <br /> ______________Distance from foundation to nearest lot lin/eq� r, <br /> ✓+��1 Number of lines-----------------------------------Length of each line..............................Width of trench------------------------------------ <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length................................._........ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. LA <br /> ❑ Number of pits______________________Lining material-----------------------Size: Diameter____-•--______.__._.___Depth__.___.___-_--___-_-._--____-_--. r_ <br /> Cesspool: Distance from nearest well............. ...Distance from foundation--------------------Lining material•__ ............................... <br /> ❑ Size: Diameter--- ------Depth-------------------------------- -------- ------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well-----------------------------------.------------.Distance from nearest building------------------------------------------ <br /> 1­1 <br /> ,--._:_•____-_-____--- _-___:__.-____.-.❑ Distance to nearest lot line------------- -•-------------------------------------------------• ..................................................... •-------- <br /> 9 and/or d or re airin (describe): ` MS DD <br /> repairing ( -----•--- -L------------------------ -•_-................................................... <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 S n Joaquin Local Health District. <br /> (Signed)------------------------------------------------------------------------- ------ -- ------------------------------------------------------------------------(Owner and/or Contractor)_ <br /> By:................................................------•-•---- ----- ---------- ------.......................................(Title)---------------------------------------------- ------- ------- <br /> (Plot plan, showing size of lot, location of stem i relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------4-- -------- ------------------_------............................. DATE.................... <br /> _;; p <br /> REVIEWED BY------------------------------------------ ------ �-� � <br /> Y ------------------------------------------------------. DATE......... •--•--- <br /> ---•---------•--------- <br /> - ---- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------–...................................... DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:............................................................................................................................................................... <br /> ------------------------------------------------ ---------•-•----------------------------------------------------------------...---------------...----------------•------------------------------------------------ <br /> ----------------------------------- -------------------------------------•---------------- ------------------------------------------------------------------------------....---- <br /> ---------------------- ----------------------------- --�------------------------ -----------------------------------------------------------------------------------------------_....__.....----••-- ...... <br /> / , <br /> FINAL INSPECTION BY:........"_� ,rh ------------------------------ Date---------4� AI 41----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wort Oak Street 124 Sycamore Street 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E■-9 NEVIGED 8-69 F.P.CD.2M 6.60 <br />